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Hygiene  and  Morality 

A  Manual  for  Nurses  and  Others,  Giv- 
ing  an    Outline  of   the   Medical, 
Social,  and  Legal  Aspects  of 
the  Venereal  Diseases 


By 

Lavinia  L.  Dock,  R.N. 

Graduate  of  Bellevue  Hospital  Training  School,  Resident  Member  of  the 

Nurses'  Settlement,  New  York,  Secretary  of  the 

International  Council  of  Nurses 


G.  P.  Putnam's  Sons 

New    York     and     London 
^be    ftnicfterbocftcc    press 


Copyright,  19  io 

BY 

LAVINIA  L.  DOCK 

Published,  June,  1910 

Reprinted,  October,  1910  ;  February,  ign 

January,  1912 


"ISbc  'Knfcfserbocfier  ^vc6e,  l^ew  l^ot^ 


PREFACE 

TTHE  plan  of  this  manual  has  grown  from  the 
■■■  scope  of  a  paper  presented  by  the  author 
to  the  International  Congress  of  Nurses  in  Lon- 
don, in  July,  1909,  in  which  the  chief  purpose 
aimed  at  was  the  same  as  has  been  here  followed, 
namely,  to  reiterate  the  social  significance  of  the 
venereal  diseases  and  the  crusade  upon  which 
women  should  enter  in  regard  to  them.  There- 
fore, though  the  book  is  meant  primarily  for  the 
musing  profession  with  its  many  thousands  of 
members,  it  has  not  been  arranged  simply  as  a 
text -book  on  diseases,  and  the  author  hopes  it 
may  be  useful  to  many  other  women  as  well. 
The  author's  thanks  are  to  be  cordially  expressed 
to  Dr.  Elizabeth  Hurdon  and  Dr.  Florence  Sabin, 
both  of  the  Johns  Hopkins  Medical  School,  for 
reading  the  text  on  the  Venereal  Diseases;  to 
Dr.  Caroline  Hedger,  member  of  the  Chicago 
Society  of  Social  Hygiene,  who  has  read  the  whole 

text;  to  Dr.  Louis  I.  Dublin  of  Brooklyn  for  in- 

iii 


iv  Preface 

formation  relating  to  industrial  insurance,  and  to 
Miss  Alice  Henry  of  Hull  House  for  notes  on 
maternal  subsidies. 

Lavinia  L.  Dock,  R.  N. 


The  Nurses*  Settlement 

265  Henry  St.,  New  York. 


By  Lavinia  L.  Dock 


AText-Book  of  Materia  Medica  for 
Nurses.  Fourth  Edition,  Revised 
and  Enlarged.     Cr.  8vo.     Net,  $1.50 

History  of  Nursing.  The  Evolution 
of  the  Methods  of  Care  for  the  Sick 
from  the  Earliest  Times  to  the  Foun- 
dation of  the  First  English  and  Ameri- 
can Training  Schools  for  Nurses.  By 
Lavinia  L.  Dock,  R.N.,  and  M. 
Adelaide  Nutting,  R.N.  Two  vol- 
umes, 8vo.  Fully  illustrated.  Net, 
Iq.oo. 


CONTENTS 

CHAPTER  PAGB 

Part  I. — The  Venereal  Diseases  i 

I.     Syphilis .3 

IL      GONORRHCEA  AND  CHANCROID  .  .         40 

Part  II. — Prostitution  57 

I.    Control  and  Regulation  of  Prostitu- 
tion      ......       59 

II .    The  White  Slave  Traffic     .         .         .104 

Part  III.    The  Prevention  of  Venereal 

Disease  127 

I.    Underlying  Principles  OF  Prevention  .     129 

Appendices  .         .         .         .         .         .171 

Index 195 


Part  I.      The  Venereal  Diseases 


CHAPTER  I 

SYPHILIS 

THE  venereal  diseases  are,  in  the  commonly 
accepted  order  of  their  gravity:  Syphilis; 
Gonorrhoea;  Chancroid.  The  first  mentioned  is, 
by  many  modem  medical  writers,  classed  by  itself, 
as  will  be  explained  later.  For  a  long  period  in 
medical  history,  these  three  were  all  believed  to  be 
manifestations  of  one  and  the  same  disease.  This 
confusion  of  ideas  continued  until  the  identifica- 
tion of  the  specific  causative  germs  brought 
definite  imderstanding  and  gave  a  sound  basis 
to  theory. 

Historical  Outline.     Venereal  diseases  are  of 

great,   probably  of  unknown    antiquity.      Some 

writers  say  that  gonorrhcea  has  always  existed. 

Syphilis  appears  to  accompany  certain  stages  of 

civilisation,  as  at  least  some  barbarous  tribes  are 

and  have  been  free  from  it.      It  is  known  that  it 

has  been  introduced  into  certain  ones  of  such 

tribes  by  white  men.     This  has  recently  occurred 

3 


4  Hygiene  and  Morality 

with  decimating  results  in  the  case  of  the  tribe 
of  Baganzas  in  Central  Africa. 

Some  medical  historians  affirm  that  syphilis 
was  unknown  in  Europe  before  the  discovery  of 
America  and  that  it  was  carried  thence  into 
Europe,  having  presumably  had  its  source  in 
the  ancient  civilisations  of  Central  America. 
Prominent  authorities  hold  this  view,  while 
others,  also  prominent,  maintain  that  it  has  existed 
for  many  more  centuries  in  Europe  but  has  been 
confused  with  leprosy.  The  controversy  is  one 
of  no  more  than  academic  interest.  What  is 
historically  certain  is,  that  an  epidemic  of  syphilis 
of  frightful  virulence  raged  in  Europe  at  the  end 
of  the  fifteenth  century,  constituting  a  veritable 
plague,  and  that  it  spread  to  all  the  countries  and 
corners  of  the  continent.  Since  then,  it  has 
been  ever  present  in  a  less  spectacular,  sub-acute 
form  as  an  endemic  disease.  Though  now  less 
noticeable,  it  is  no  less  pestilential;  perhaps 
indeed  it  is  even  more  dangerous  by  reason  of  its 
concealment,  as  it  is  thus  able  to  promote  un- 
discovered that  racial  degeneration  which  has 
been  pointed  out  as  one  of  its  chief  activities. 

Cause  of  Syphilis.      Syphilis  is  caused  by  a 


Syphilis  5 

micro-organism  called  the  SpirochcEte  pallida  of 
Schaudinn.  This  micro-organism,  the  specific  and 
invariable  cause  of  syphilis,  has  not  long  been 
known  with  certainty,  though  long  before  its 
actual  demonstration  medical  specialists  had 
suspected  its  existence.  Metchnikoff  records  the 
work  of  Donne,  a  French  microscopist,  who,  in 
1837,  tried  to  learn  from  his  microscope  the  exact 
nature  of  the  .s^enito-urinary  discharge  in  both  men 
and  women.  But  his  efforts  resulted  in  nothing 
definite.  In  his  day  the  germ  theory  was  non- 
existent. After  the  work  of  Pasteur  had  given  a 
new  direction  to  medical  and  surgical  study  and 
had  caused  the  doctrine  of  the  action  of  micro- 
organisms as  the  cause  of  infectious  disease  to  be 
accepted,  active  search  and  research  went  on  in 
laboratories  all  over  the  world,  to  discover  the 
germs  of  this  as  well  as  of  other  diseases.  But 
for  twenty  years  or  more  the  definite  attempts 
made  by  Weigart,  Lustgarten,  Metchnikoff,  and 
many  others  to  find  the  cause  of  syphilis  ended 
in  failure.  Finally  a  commission  of  experts  was 
formed  under  the  lead  of  Schulze,  Professor  of 
Zoology  in  the  University  of  Berlin,  and  the  in- 
vestigation directed  toward  the  discovery  of  the 
syphilitic  virus  was  by  him  entrusted  to  Schaudinn 


6  Hygiene  and  Morality 

and  Hoffman,  who,  finally,  were  successful  in 
their  search,  and  in  1905  were  able  to  demon- 
strate the  micro-organism  which  is  now  generally 
accepted  by  the  medical  profession  as  the  cause 
of  syphilis. 

Schaudinn's  Discovery.  It  was  shown  that 
two  varieties  of  Spirilla  were  to  be  found  in  normal 
and  in  diseased  states  of  the  genital  organs.  The 
first  variety,  called  Spirilla  refringens,  may  be 
existent  in  either  state,  and  may  be  demonstrated 
in  different  pathological  conditions,  both  non- 
syphilitic  and  syphilitic  in  character.  The  second 
variety,  the  Spirilla  pallida,  is  only  found  in 
syphilis,  not  even  in  other  venereal  diseases  unless 
syphilis  is  also  present. 

The  Spirochete  Pallida.  The  SpirochcBte 
pallida  is  classed  among  the  Spirilla.  It  is 
not  yet  definitely  settled  whether  it  belongs 
to  the  bacteria  or  the  protozoa.  This  uncer- 
tainty, which  is  practically  unimportant,  may 
be  ended  any  day,  as  active  study  of  its  nature 
is  constantly  going  on  under  such  masters  as 
Metchnikoff,  Roux,  and  others.  Bloch,  a  high 
authority,  calls  it  a  protozoon. 


Syphilis  7 

Metchnikoff  points  out  the  fact  that  the  female 
genital  organs  are  the  home  of  other  forms  of 
Spirilla,  which  may  at  times  be  mistaken  for  the 
SpirochcBie  pallida.  Beside  the  Spirochcste  re- 
fringens  there  is  still  another,  the  Spirochcste 
balanitis,  and  these,  being  sometimes  found  in 
lesions  of  syphilis,  have  been  called  secondary 
organisms. 

The  SpirochcBte  pallida  is  a  delicate  organism. 
It  is  smaller  and  slenderer  than  the  other  Spirilla 
mentioned,  and  has  more  spirils.  It  has  been 
called  ''pallida,'"  the  pale  Spirochcete,  because  of 
the  technical  difficulty  of  staining  it  for  observa- 
tion in  laboratory  work.  Schaudinn,  it  is  said, 
first  named  it  SpirochcBte  pallida,  later  called  it 
SpirochcBte  pallidum,  and  still  later  Treponema 
pallidum.  The  first  name  remains  the  one  in 
general  use. 

It  only  survives  for  a  few  hours — six,  Andrews 
says — outside  of  the  human  body.  After  that  its 
infectious  power  is  lost.  It  is  destroyed  by  heating 
for  an  hour  to  51  degrees  Centigrade  (i2  4°Fahr. 
approximately).  It  needs  moisture,  and  if  dried 
dies  quickly,  but  even  with  moisture  present  it 
is  very  perishable  when  removed  from  its  human 
host.     This  readily  perishable  quality  and  early 


8  Hygiene  and  Morality 

loss  of  pathogenic  power  is  of  the  highest  im- 
portance in  considering  the  subject  of  contagion 
by  direct  mechanical  contact  with  infected  ob- 
jects, as  will  be  seen  later,  and  has  a  definite 
bearing  on  practical  methods  of  disinfection  and 
on  the  avoidance  of  direct  infection  from  inani- 
mate objects  and  personal  contact. 

So  far,  efforts  to  cultivate  the  Spirochcste  in 
artificial  media  have  not  succeeded,  but  this,  too, 
may  be  accomplished  any  day,  as  all  the  famous 
bacteriological  laboratories  of  the  world  are  ex- 
perimenting on  this  line. 

General  Results  of  Experiments.  Experi- 
mental work  so  far  has  been  successful  in 
demonstrating  the  SpirochcBte  pallida  in  the 
primary,  secondary,  and  tertiary  lesions  of  syphi- 
lis; in  the  lymphatic  organs  and  the  lymph;  in  the 
saliva  and  urine;  in  arterial  lesions;  in  the  foetus, 
and  in  the  newborn  congenitally  syphilitic  infant, 
which,  indeed,  always  shows  enormous  numbers 
of  the  specific  germ  in  its  various  organs.^  It 
has  also  been  occasionally  demonstrated  in  the 
blood.  Further,  experimental  work,  chiefly  that 
carried   on  in  the   Pasteur  Institute   under  the 

1  Metchnikoff. 


Syphilis  9 

direction  of  Metchnikoff,  and  by  Neisser  in  Java, 
has  been  successful  in  transmitting  the  disease 
syphilis  to  certain  varieties  of  apes,  and  in  thus 
clearing  up  some  important  and  formerly  un- 
known facts  and  principles  that  are  of  value  for 
early  and  correct  diagnosis  and  treatment. 

Thus  it  has  been  shown  that  the  virus  of  syphilis 
can  be  demonstrated  in  the  internal  organs  within 
sixteen  days  after  infection,  and  long  before 
the  usual  time  of  appearance  of  the  earliest  outward 
sign  of  the  disease,  namely,  the  ''primary  sore."^ 
Unremitting  attempts  made  to  obtain  a  prophy- 
lactic serum  or  mitigated  virus  such  as  has  been 
successfully  produced  for  diphtheria,  tetanus,  etc., 
have  so  far  been  only  partially  successful,  but, 
though  some  scientists  regard  the  production  of 
such  a  serum  or  vaccine  as  a  doubtful  possibility, 
the  efforts  to  produce  it  will  no  doubt  go  on  until 
it  has  been  accomplished. 

The  proof  of  the  early  extinction  of  the  life  of 
the  germ  after  being  removed  from  the  body  is  one 
of  the  important  results  of  experiment,  and,  in 
the  work  with  apes,  a  number  of  data,  valuable 
for  diagnosis  and  treatment,  have  been  secured, 
notably  that  of  the  "serum  diagnosis"  of  Neisser, 

i  Xeisser. 


lo  Hygiene  and  Morality 

Wassermann,  and  Brink.  This  is  based  upon  the 
natural  reaction  that  takes  place  in  the  blood  after 
the  introduction  of  certain  poisons,  and  the  ap- 
pearance in  the  blood  of  so-called  ''antibodies," 
or  natural  antagonists  to  the  poison  in  question. 
These  "antibodies,"  normally  not  demonstrable 
by  ordinary  methods  of  examination,  may  increase 
and  be  found  in  large  quantities  under  the  stim- 
ulus of  the  disease  poison.  Their  presence  in 
syphilis  is  now  regarded  as  an  important  passive 
aid  to  diagnosis,  though  their  absence  would  not 
necessarily  prove  the  non-existence  of  the  disease. 
The  effects  of  the  drugs  u&ed  in  the  clinical 
treatment  of  syphilis,  especially  mercury,  have 
also  been  extensively  and  usefully  studied  in  the 
course  of  animal  experimentation. 

Symptoms  and  Course  of  Syphilis.  Syphilis 
has  been  defined  as  a  specific  disease  of  slow 
evolution,  propagated  by  inoculation  (acquired 
syphilis) ,  or  by  hereditary  transmission  (congenital 
syphilis) .  ^ 

Acquired  syphilis  is  invariably  due  to  direct 
contact  with  the  discharges  or  secretions  of  a 
patient  already  suffering  from  the  disease.     It  is 

»  Osier, 


Syphilis  ii 

supposed  that  some  minute  break  or  abrasion 
in  the  skin  or  mucous  membrane  exposed  to  the 
virus  is  a  condition  of  infection,  though  this  break 
may  be  too  minute  to  be  noticeable.  The  squamous 
epithelium  seems  to  be  the  primary  channel  of 
infection.  The  germ  of  syphilis  cannot  be  trans- 
mitted through  the  atmosphere  in  dust  particles, 
as  may  happen  in  the  case  of  the  tubercle  bacillus. 

Syphilis  is  an  infectious  fever,  nmning  a  slow  or 
chronic  course,  and,  like  other  fevers,  it  has  a 
period  of  incubation  followed  by  acute  symptoms 
including  skin  eruptions  and  general  disturbances 
of  the  health,  and  it  has,  later,  sequels  or  remote 
consequences  of  definite  and  varied,  often  of  fright- 
ful character.  Unlike  other  fevers,  which  run 
their  course  in  a  few  weeks,  this  one  lasts  for 
months  and  even  for  years,  while  its  sequels,  like 
those  of  scarlet  fever,  are  permanent  and  terrible 
in  their  nature. 

The  course  of  syphilis  is  divided  into  three 
stages :  primary,  secondary,  and  tertiary. 

Primary  Stage.  The  primary  stage  begins 
with  the  close  of  the  incubation  period,  while 
incubation  itself  may  take  from  ten  days  to 
seven    weeks    after    the    time    of    exposure    to 


12  Hygiene  and  Morality 

infection.  This  variance  in  time  is  supposed  to 
be  due  to  the  varying  number  of  SpirocluEte 
pallida  present  in  the  infectious  material  or 
discharges  by  which  the  disease  is  carried.  The 
average  period  of  incubation  is  three  or  four 
weeks.  During  this  time  there  are  no  signs  of 
disturbance,  and  the  abrasion  through  which  the 
poison  has  been  received,  heals. 

Finally,  at  the  end  of  the  incubation  period, 
a  small  red  papule  appears  at  the  point  of  inocu- 
lation. It  may  or  may  not  enlarge.  A  little  later 
it  breaks  down  in  the  centre,  forming  an  ulcer, 
small  or  large  as  the  case  may  be,  but,  as  a  rule, 
single.  This  is  known  as  the  "hard  chancre,'* 
from  the  fact  that  the  tissues  about  it  are  indurated 
and  dense,  with  a  gristle-like  feeling,  and  it  is 
known  as  the  ''primary  lesion"  or  "initial  sore" 
of  syphilis.  The  discharge  from  this  ulcer  is 
highly  contagious,  yet,  if  the  ulcer  is  of  small  size, 
it  may  be  readily  overlooked.  In  the  primary 
stage  there  may  be  no  disturbance  of  the  general 
health,  nor  any  symptoms  that  attract  attention. 
The  primary  stage  continues  for  from  one  to  three 
months  with  no  other  signs  of  trouble  than  the 
primary  lesion  itself.  This  quiescent  period  is 
sometimes  called  the  second   incubation  period. 


Syphilis  13 

At  its  close,  rarely  later  than  the  twelfth  week,  an 
active  set  of  constitutional  symptoms  come  on. 

Secondary  Stage.  The  poison  has  now  been 
distributed  by  the  lymphatic  system,  as  evidenced 
by  enlargement  of  the  glands  in  all  parts  of  the 
body.  There  may  be  fever,  more  or  less  marked 
and  of  variable  character,  and  skin  eruptions, 
also  of  very  varied  characteristics,  the  most  usual 
being  a  rash  resembling  measles  which  appears 
first  on  the  chest  and  abdomen,  spreading  thence  to 
other  parts  of  the  body.  One  form  of  the  eruption 
resembles  smallpox ;  others  bear  resemblance  to  skin 
diseases  of  different  origin  and  varying  features. 
There  is  severe  nocturnal  headache  and  pain  in 
the  bones,  with  a  general  feeling  of  illness.  The 
inner  surfaces  of  the  mouth  and  all  the  structures 
of  the  pharynx  and  throat  may  become  sore,  red, 
and  swollen,  sometimes  so  acutely  so  that  solid 
food  caimot  be  swallowed.  The  mucous  patches 
which  are  among  the  most  significant  and  special 
symptoms  of  syphilis  may  appear  on  all  or  any 
parts  of  the  inner  surfaces  of  the  mouth  and  gums, 
tongue,  tonsils,  and  phar3nix.  They  may  also 
appear  at  the  comers  of  the  lips,  or  in  the  nasal 
lining,  or  in  the  folds  of  the  axillae  and  the  peri- 


14  Hygiene  and  Morality 

neum,  or  even  between  the  toes.  The  mucous 
patch  is  a  flat,  greyish  ulcer,  which  secretes  a 
copious,  virulently  infectious  discharge.  Other 
symptoms  of  the  secondary  stage  are  syphilitic 
iritis,  inflammation  of  the  periosteum  and  of  the 
joints,  alopecia,  syphilitic  onychia,  and  condylo- 
mata, or  the  "syphilitic  warts"  which  are  fre- 
quently found  in  the  vulvar  region.  The  labyrinth 
of  the  ear  may  be  involved  and  deafness  result. 

Tertiary  Stage.  The  oncoming  of  the  tertiary 
stage  cannot  always  be  separated  from  the  second- 
ary stage  by  a  definite  line,  nor  can  the  symptoms 
of  the  secondary  and  tertiary  periods  always  be 
distinctly  separated  in  classification,  as,  in  some 
cases,  symptoms  usually  regarded  as  late  ones 
may  appear  early,  or,  again,  the  stages  may  not 
run  a  perfectly  typical  course.  Nor  *  does  the 
tertiary  stage  always  develop.  Tertiary  symp- 
toms, like  sequels  of  other  contagions,  are  not 
wholly  inevitable.  They  may  be  averted  by 
early,  careful  treatment  carried  on  for  a  sufficient 
length  of  time. 

When  the  third  stage  of  syphilis  does  occur, 
its  onset  may  not  take  place  for  months  or  even 
years   after   the   primary   sore.     During   a   long 


Syphilis  15 

period  the  patient  may  have  believed  himself  to  be 
entirely  well  and  free  from  danger.  This  slowness 
of  development  and  insidious  latency  of  the  dis- 
ease constitutes  one  of  its  most  dread  features. 
Andrews  says:  "No  other  communicable  disease 
continues  its  manifestations  after  twenty  and 
even  fifty  years  after  the  original  infection." 

It  is  beheved  that  the  chief  cause  contributory 
to  the  development  of  tertiary  symptoms  is 
inadequate  treatment  in  the  very  early  stages. 
As  a  result  of  this  inadequacy  of  care  it  may 
happen  that  cases  which  appeared  mild  and 
insignificant  at  the  outset,  and  which,  in  conse- 
quence, may  have  received  only  brief  or  super- 
ficial treatment,  develop  most  malignant  and 
violent  tertiary  symptoms.  There  are,  however, 
some  cases  where  the  virulence  of  the  poison 
defies  all,  even  early,  treatment. 

As  a  rule,  the  general  condition  of  the  patient 
and  of  his  surroundings  have  much  bearing  upon 
the  probable  results  of  treatment.  If  the  general 
health  is  good,  surroundings  sanitary,  and  treat- 
ment adequate  and  faithfully  followed,  the  pa- 
tient may  generally  feel  hopefiil  of  cure. 

Alcoholism  makes  the  prognosis  much  worse, 
and  bad  hygienic  living  conditions  also  add  to 


1 6  Hygiene  and  Morality 

a  discouraging  outlook.  The  parasites  may  not 
be  actually  killed,  but  only  rendered  latent  and 
may,  in  consequence,  produce  tertiary  symptoms 
at  a  remote  period. 

The  typical  characteristics  of  the  third  period 
of  syphilis  are  **gummata"  or  soft  tumors  which 
may  develop  in  any  set  of  tissues,  from  the  hard 
bony  structure  through  the  whole  range  of  internal 
organs  to  the  brain  and  skin.  These  tumors  or 
gumma  tend  to  ulceration  and  destruction  of 
tissues,  and  produce  the  deformities  sometimes 
seen,  such  as  the  destruction  of  the  bridge  of  the 
nose,  etc.  Skin  eruptions  of  a  more  formidable 
type  than  the  earlier  ones,  and  having  a  more 
pronounced  tendency  to  ulcerate,  appear  in  this 
stage. 

Congenital  Symptoms.  Every  feature  of  the 
acquired  disease  except  the  primary  sore,  says 
Dr.  Osier,  may  be  seen  in  the  congenital  form. 
The  baby  born  with  syphilis  is  wasted  and 
withered,  with  the  wrinkled  ''old"  looking  little 
face ;  fissures  at  the  corners  of  the  mouth ;  a  dis- 
charge from  the  nostrils,  "snuffles";  ulcerated 
lips;  excoriated  buttocks;  dry  and  unhealthy 
skin;  eruptions,  especially  about  the  extremities: 


Syphilis  17 

some  or  all  of  these  symptoms  may  be  present. 
The  baby  with  these  marked  evidences  of  disease 
is  not  likely  to  live.  Or,  the  baby  may  be  born 
healthy  looking  and  well,  but  after  a  few  weeks' 
time  may  develop  sniifQes,  eruptions,  fissures 
about  the  mouth,  loss  of  hair  and  eyebrows, 
or  other  less  markedly  characteristic  symptoms. 
This  process  usually  occurs  between  the  third  and 
twelfth  week.  Children  with  congenital  syphilis, 
says  Osier,  rarely  thrive.  Certain  ones  may 
improve  or  recover,  but  there  is  apt  to  be  a  return 
of  the  disease  at  puberty.  Even  those  who  recover 
from  the  early  symptoms  do  not  develop  normally. 
They  often  have  a  wizened,  wasted  look,  their 
growth  is  slower,  and  there  is  a  frequent  condition 
known  as  ''infantilism"  which  gives,  for  instance, 
to  the  youth  of  nineteen  the  appearance  of  a  boy 
of  twelve. 

About  the  time  of  puberty,  the  child  with 
inherited  syphilis  may  develop  persistent  eye  and 
ear  diseases.  Of  all  the  organs  of  special  sense, 
the  eye  is  the  one  most  frequently  attacked. 
Disease  of  bones  may  appear  early  or  late,  and 
the  late  case  of  hereditary  syphilis  may  display 
the  dread  gummata  and  end  in  general  paresis. 
The  lesions  of  the  third  stage  are  also  infectious, 


1 8  Hygiene  and  Morality 

though,  as  they  are  often  situated  in  deep  seated 
tissues,  there  is  less  opportunity  for  the  infection 
to  be  conveyed  to  others. 

The  congenitally  syphilitic  infant  is  intensely 
infectious.  Fournier  says:  "Nothing  is  so  dan- 
gerous to  its  surroundings  as  a  syphilitic  infant." 

Syphilis  Hereditary  in  the  Literal  Sense. 
Syphilis  is  hereditary,  not  in  the  sense  of  an 
inherited  predisposition  only,  as  is  the  case  with 
tuberculosis  (once  believed  to  descend  as  an 
actual  entity  from  one  generation  to  another), 
but  the  disease vitself  may  be  inherited.  In  other 
words,  the  new-born  baby  may  come  into  the 
world  with  the  Spirochcete  pallida  present  in 
enormous  numbers  in  all  or  in  any  of  its  tissues. 
Morrow  says:  "Syphilis  is  the  only  disease  which 
is  transmitted  in  full  virulence  to  the  offspring." 

Heredity  to  the  Third  Generation.  It  is 
a  matter  of  some  difference  of  opinion  and  con- 
troversy whether  syphilis  is  transmissible  to  the 
third  generation.  The  French  school,  fairly 
generally,  some  American  writers,  and  Hutchin- 
son, the  English  authority,  take  the  negative, 
while  many  others  withhold  a  positive  pronounce- 


Syphilis  19 

ment.  In  the  absence  of  a  definite  certainty, 
however,  one  cannot  but  recall  the  words  of  the 
Old  Testament,  ''The  sins  of  the  fathers  are  visited 
upon  the  children,  even  unto  the  third  and  fourth 
generations,"  and  surmise  that  they  may  reflect 
the  accumulated  wisdom  of  ages  of  experience.  In 
this  connection  it  m^ay  be  remembered  too  that 
the  exact  study  of  S3'phili5  is  novr,  according  to 
distinguished  medical  writers,  only  in  its  infancy. 

It  is  supposed  that,  in  a  large  number  of  cases, 
the  syphilitic  taint  is  derived  from  the  father  only; 
that  the  semen  conveys  the  SpiroclicBte  pallida 
directly  to  the  product  of  conception.  It  is  also 
authoritatively  taught  that,  if  the  mother  alone 
has  transmitted  the  disease  to  the  offspring  the 
danger  is  graver — the  fatahty  to  the  children 
more  overwhelming  than  if  the  father  alone  has 
transmitted  it.  Recent  studies  em^phasise  the 
predominant  part  of  the  mother  in  heredity. 

A  phenomenon  first  pointed  out  by  a  noted 
surgeon  of  Dublin,  Colles,  and  named  after  him, 
is  that  of  a  mother  who,  herself  apparently  free 
from  the  disease,  gives  birth  to  a  child  showing 
congenital  taint,  and  can  herself  nurse  her  baby 
without  becoming  infected  by  it,  whilst  the  most 
healthy  wet-nurse  nursing  the  same  baby  becomes 


20  Hygiene  and  Morality 

infected.  But  it  seems  to  be  a  question  whether 
this  mother,  who  appears  to  be  immune,  really 
is  so  or  not.  Osier  speaks  of  her  as  receiving 
a  ''protective  inoculation."  Hutchinson  makes 
the  observation  that  it  would  be  important  to 
know  how  many  such  mothers  showed  tertiary 
symptoms  in  later  life.  This  is  at  present  not 
known,  but  he  believes  there  is  proof  that  there 
are  many,  and  holds  this  to  be  corroborative  of 
the  view  that  such  mothers  really  do  receive  an 
infection  during  pregnancy.  The  whole  subject 
is  one  of  present  incertitude,  and  with  further 
research  is  likely  to  be  completely  revised.  An- 
other phenomenon  which  has  been  called  after 
Profeta  is  that  of  a  child  apparently  healthy 
which  nurses  its  syphilitic  mother  without  be- 
coming infected.  This  also  must  be  taken  with 
reserve  as  needing  further  exact  investigation. 

Finally,  it  is  supposed  that  the  offspring  may  es- 
cape infection  altogether  if  the  mother  is  not  in- 
fected until  late  in  pregnancy,  especially  if  not 
until  after  the  seventh  month. 

Immunity.  A  study  of  the  most  recent  writings 
gives  the  impression  that  it  is  regarded  as,  on  the 
whole,  doubtful  whether  a  true  natural  immunity 


Syphilis  21 

against  syphilis  exists  in  the  human  individual. 
D'Arcy  Power  says  that,  as  far  as  is  now  known, 
no  healthy  person  is  proof  against  syphilis,  but 
that  any  one  who  is  directly  exposed  to  it,  in  the 
literal  sense  of  having  the  Spirochcete  pallida 
introduced  into  the  lymphatic  system,  will  con- 
tract the  disease.  Nor  is  there  a  certainty  as  to 
acquired  immunity.  Neisser  holds  that,  in  the 
case  of  syphilis,  there  is  no  such  thing  as  the  ac- 
quired immunity  which  is  familiar  as  following 
upon  some  other  contagious  diseases — that  is, 
when  an  individual,  having  once  had  a  contagious 
disease  and  having  been  cured,  is  thereafter 
insusceptible  to  it.  He  teaches,  as  the  result 
of  his  investigations  with  animals,  that  cases 
which  appear  to  display  immunity  and  resistance 
to  fresh  infection  are  really  not  cured,  but  have 
the  Spirochcete  pallida  still  present  in  their 
tissues,  and  that  cases  which  had  been  really 
cured  by  treatment,  i.  e.,  when  the  microscope 
proved  that  the  Spirochcete  had  actually  been 
killed,  were  susceptible  to  new  infection. 

While  it  is  not  always  correct  to  make  precise 
deductions  from  animal  experimentation  for  man 
he  believes  that  this  is  also  true  of  htmian  beings — 
that  cases  of  so-called  ''immunity"  are  not  such, 


22  Hygiene  and  Morality 

but  that  these  individuals  still  have  the  Spiro- 
chcete  pallida  present  in  their  tissues.  In  October, 
1908,  he  stated  that  no  method  of  procuring 
active  or  passive  immunity,  nor  mode  of  treat- 
ment with  immunising  substances,  had  been 
discovered. 

On  this  point,  Hutchinson  says  that  he  has 
seen  seven  cases  of  true  second  attacks  of  syphilis 
at  intervals  of  from  eighteen  months  to  twelve 
years  after  the  first  attack.  The  possibility  of 
a  second  attack,  is  therefore,  he  believes,  only 
the  expression  of  the  efficiency  of  the  treatment 
of  the  first.  Lang  of  Vienna  says  that  for  a  long 
time  there  was  a  belief  in  the  absolute  immun- 
ity conferred  by  a  first  attack  of  syphilis  but  that 
this  belief  was  disproved  by  Zeissl  and  others. 
Reinfection,  he  holds,  can  only  occur  in  individuals 
who  have  been  perfectly  cured.  Those  in  whom 
the  disease  is  still  present  are  not  susceptible  to 
new  infection. 

Reinfected  cases  usually  run  a  mild  course. 
So,  too,  it  is  believed  that  races  in  which  syphilis 
has  long  been  widely  prevalent  show  a  less  obvious 
type  of  symptom. 

Relation  of  Syphilis  to  the  Nervous  Sys- 


Syphilis  23 

TEM.  The  relation  of  syphilis  to  a  number  of  the 
disorders  of  the  nervous  system  had  only  been 
imperfectly  understood  up  to  the  time  of  the 
discovery  of  the  SpirochcEte  pallida.  Careful 
studies  are  now  being  pressed  along  this  line,  and 
it  cannot  be  doubted  that  the  rapid  progress  of 
modern  medical  science  will  continuously  throw 
new  light  upon  these  obscure  problems,  to  the 
incalculable  benefit  of  the  human  race. 

Some  diseases  of  the  nervous  system  are 
directly  due  to  syphilis,  as  hemiplegia  from 
syphilitic  degeneration  of  the  walls  of  arteries; 
and "  paralysis  or  convulsions  due  to  syphilitic 
tumors  of  the  brain  or  those  lying  at  the  roots 
of  nerves. 

Again,  some  of  the  most  formidable  nervous 
diseases,  classed  as  para-syphilitic,  are  regarded 
not  as  in  themselves  syphilitic,  but  as  resulting 
in  some  way  from  the  virus  of  syphilis  or  from 
the  changes  it  has  brought  about  in  the  organs. 
Prominent  among  these  are  locomotor  ataxia  and 
the  general  paralysis  of  the  insane.  It  was 
formerly  held  that  the  first  mentioned  disease 
might  arise  from  other  causes;  that,  though  the 
great  majority  of  cases  were  of  definitely  syphilitic 
origin,  a  certain  percentage  of  the  remainder  must 


24  Hygiene  and  Morality 

not  be  so  regarded.  But  the  more  recent  writers 
tend  to  the  assumption  that  the  syphilitic  taint 
is  invariably  to  be  found  in  the  previous  history, 
even  though  it  may  be  many  years,  or  a  full 
generation,  earlier.^ 

The  Relation  of  Syphilis  to  Carcinoma. 

Recent  writers  point  out  the  great  importance  of 
further  investigation  into  the  obscure  relationship 
between  syphilis  and  carcinoma.  D'Arcy  Power 
states  that  cancer  is  peculiarly  liable  to  occur 
in  the  tissue  which  has  undergone  a  chronic 
syphilitic  inflammatory  process,  and  speaks  of  the 
virus  of  syphilis  as  "preparing  the  tissues"  for 
cancer,  especially  that  form  of  it  known  as  epithe- 
lioma. While  there  is  no  reason  for  supposing  that 
syphilis  is  closely  related  to  carcinoma  yet  its 
importance  as  a  predisposing  or  favourable 
condition  for  the  development  of  this  terrible 
affliction  should  give  added  weight  to  every  argu- 
ment for  the  extirpation  of  syphilis  from  human 
society. 

Syphilis  and  Tuberculosis.  The  author  just 
quoted  points  out  the  inter-relation  between 
syphilis    and    tuberculosis,    and    believes    that 

1  Mott  in  British  Medical  Journal,  Feb.  27,  1909. 


Syphilis  25 

syphilitic  tissues  are  more  liable  to  infection  by 
the  bacillus  of  tuberculosis  than  other  equally 
ill-nourished  tissues  are,  if  syphilis-free.  He 
emphasises  the  interaction  between  the  two  dis- 
eases, while,  at  a  recent  meeting  of  the  American 
Society  of  Sanitary  and  Moral  Prophylaxis  the 
statement  was  made  that,  if  syphilis  could  be 
wiped  out,  a  vast  amount  of  the  tuberculosis 
now  existent  would  also  disappear. 

Syphilis  and  other  Diseases.  In  a  general 
way  it  may  be  stated  that  syphilis  constitutes  a 
predisposition  to  bear  all  other  constitutional 
diseases  badly.  The  intemperate,  the  tubercu- 
lous, the  rheumatic,  the  malarial  patient  all  suffer 
more,  and  find  themselves  in  a  less  hopeful  condi- 
tion when  syphilis  or  the  syphilitic  degeneration 
is  present  as  a  complication. 

Syphilis  and  Alcoholism.  A  relationship  or 
affinity  appears  to  exist  between  syphilis,  alcohol, 
and  prostitution  which  unites  them  in  a  trio  of 
great  and  evil  menace  to  health.  Dr.  Morrow 
says: 

Instruction  would  be  incomplete  without  a  warning 
as  to  the  influence  of  alcohol  in  the  instigation  of  im- 


2  6  Hygiene  and  Morality 

moral  relations  and  as  one  of  the  most  powerful 
auxiliaries  of  sexual  contamination.  The  r61e  of 
alcohol  in  the  propagation  of  venereal  diseases  has  not 
been  sufficiently  appreciated,  and  the  consideration 
that  every  repressive  measure  against  alcohol  will 
be  an  important  prophylactic  measure  against  the 
spread  of  venereal  diseases  has  not  received  the 
attention  it  deserves.  Perhaps  more  than  any  other 
agency,  alcohol  relaxes  the  moral  sense  while  it 
stimulates  the  sexual  impulse. 

Neisser  speaks  of  "the  fatal  r6le  of  alcoholism 
which  drives  innumerable  young  men  to  exagger- 
ated exercise  of  the  sexual  functions";  and  Pon- 
toppidan  says: 

Alcohol  is  an  inducing  and  even  a  downright  cause 
of  the  rise  and  propagation  of  venereal  diseases. 
Alcohol  paralyses  the  will  and  understanding,  and 
stimulates  sexual  and  sentimental  emotion.  Ab- 
stinence and  temperance  movements  must  be  taken 
as  important  allies  in  the  prevention  of  venereal 
diseases. 

Medical  statistics  show  that  an  excessive  pro- 
portion of  venereal  disease  has  been  contracted 
while  under  the  influence  of  alcohol.  Dr.  Forel's 
investigations  suggest  an  affinity  between  syphilis 
and  tissues  that  are  habituated  to  alcohol.  He 
finds  that  alcohol  is  oftener  the  exciting  cause  of 
infection  in  men  than  in  women,  while  it  oftener 


Syphilis  27 

induces  women  to  commit  the  first  irregular  act. 
Dr.  Morrow  states  also  that  chronic  alcoholism  is 
a  powerful  factor  in  bringing  on  the  development 
of  severe  and  extensive  lesions  of  the  skin  and 
mucous  membranes;  that  it  promotes  the  cere- 
bral disorders  of  syphilis,  and  causes  the  disease 
to  run  into  the  third  stage. 

Loxton  emphasises  the  necessity  of  cutting  off 
alcohol  entirely  in  the  treatment  of  all  venereal 
diseases,  and  cites  cases  of  gonorrhoea  where 
abrupt  relapses  with  acute  symptoms  followed 
immediatel}^  after  alcoholic  drinks  had  been 
taken.  ^ 

Ravogli  says: 

Alcoholism  when  associated  with  syphilis  is  also 
a  most  important  factor  in  crime.  We  know  the 
deleterious  influence  of  alcohol  in  individuals  affected 
with  syphilis, — so  much  so  that  the  French  speak  of  a 
special  kind  of  syphilis,  la  syphilis  alcoholisee.  Some 
writers  indeed  go  so  far  as  to  claim  that  the  general 
paralyses  of  tertiary  syphilis  only  occur  in  those 
who  have  been  addicted  to  drink. 

Syphilis  and  Crime.  A  suggestive  article  by 
Ravogli  on  syphilis  in  relation  to  crime  gives  the 
scientific    reasons    of    the    author    for    believing 

1  British  Medical  Journal,  Feb.  27,  1909. 


2S  Hygiene  and  Morality 

that  the  injurious  action  of  the  syphiHtic  virus 
upon  the  vascular  system  and  the  structures  of 
nerves  is  an  explanation  of  much  of  the  degeneracy 
that  is  evidenced  by  crime,  and  especially  by 
cruel  and  persecutory  kinds  of  crime  where  the 
perpetrator  enjoys  the  sufferings  of  others.  He 
quotes  Barthelemy,  who  says  that  **the  great 
class  of  heredo-syphilitics  forms  the  ranks  of  the 
degenerate,  unbalanced,  obnubilated  mattoids," 
and  that  this  heredity,  with  alcoholism,  is  the 
most  effective  cause  of  human  degradation. 
Ravogli  says:  "The  existence  of  moral  insanity 
admits  of  no  doubt,  and  that  it  is  often  the  result 
of  syphilitic  alterations  of  blood-vessels  is  easy 
to  demonstrate." 

While  he  does  not  mean  to  be  understood  as 
saying  that  syphilis  is  the  determining  cause  of 
crime,  he  does  believe  that  it  is  one  of  the  pre- 
disposing factors  of  crime,  and  he  then  goes  on 
to  say: 

A  strange  relation  exists  between  syphilis,  crime, 
and  prostitution — cases  of  prostitution  which  cannot 
be  explained  by  poverty  or  by  special  accident  have 
to  be  attributed  to  hereditary  syphilis.  Prostitution 
and  crime  go  hand  in  hand,  and  in  the  families 
where  the  brothers  are  criminals  the  sisters  are  pros- 


Syphilis  29 

titutes.  Syphilis  is  the  tie  between  crime  and 
prostitution  when  it  causes  the  affections  of  the 
nervous  system  resulting  in  moral  degeneration. 


Statistical  Estimates  of  Syphilis.  No  com- 
prehensive or  general  system  of  counting  the  cases 
of  syphilis  or  the  other  venereal  disorders  is  yet 
officially  established  in  any  country.  The  avail- 
able statistics,  therefore,  being  those  collected  by 
medical  specialists  in  their  own  practice  and  in 
hospital  records,  though  authoritative,  and  suf- 
ficiently startling,  have  not  the  extent  of  those 
collected  by  public  bureaus  or  health  departments. 
Nevertheless  there  are  data  enough  to  enable 
medical  experts  to  make  very  definite  assertions 
as  to  the  prevalence  of  venereal  diseases  and 
their  share  in  morbidity  and  mortality. 

The  general  prevalence  of  syphilis  is  estimated 
at  from  five  to  eighteen  per  cent,  of  popula- 
tions, some  countries  having  a  worse  record  than 
others.  It  is  stated  in  medical  writings  that  from 
ten  to  fifteen  per  cent,  of  the  male  population  of 
Europe  have  syphilis. 

Destruction  of  the  foetus  and  a  heavy  infant 
mortality  are  prominent  results  of  syphilis. 
Morrow  says:  "No  disease  has  such  a  murderous 


30  Hygiene  and  Morality 

influence  upon  the  offspring."  It  is  known  that 
syphiHs  is  responsible  for  a  large  percentage  of  all 
miscarriages,  while  the  death-rate  of  congeni- 
tally  syphilitic  infants  is  described  by  the  ex- 
pression ''Poly-Mortality." 

Figures  taken  from  European  hospital  records 
and  from  physicians'  note-books,  all  classes  of  the 
community  being  considered  as  one,  show  a  double 
fatality  when  both  parents  are  infected,  or  an 
infant  death-rate  of  sixty-eight  per  cent.  In  pri- 
vate practice  only,  the  social  status  here  being 
rather  superior,  the  infant  mortality  is  sixty  or 
sixty-one  per  cent.  Free  pubhc  hospitals,  where 
the  most  indigent  cases  find  refuge,  show  the  worst 
figures,  from  eighty-four  to  eighty-six  deaths  in 
every  hundred  infants.  One  in  every  four  or  five 
lives  long  enough  to  pass  the  heritage  on.  Phy- 
sicians record  instances  of  the  extinction  of  entire 
families  from  syphilis.  Fournier  cites  one  such 
case,  where,  to  157  births,  there  were  157  deaths 
from  this  cause.  In  the  Transactions  of  the 
American  Society  of  Sanitary  and  Moral  Prophy- 
laxis the  statement  is  made  that  in  France  alone 
syphilis  kills  twenty  thousand  children  annually. 
The  ages  at  which  syphilis  is,  in  a  large  proportion 
of  cases,  contracted,  give  melancholy  testimony 


Syphilis  31 

to  the  prevalent  neglect  of  the  young.  There  are 
authentic  medical  figures  showing  that  from 
thirty  to  forty  per  cent,  of  the  cases  of  this  disease 
are  infected  between  the  ages  of  fourteen  and 
twenty  years. 

Besides  the  hereditary  infection  of  children  by 
their  parents  the  infection  of  wives  by  their  hus- 
bands is  common.  Morrow's  records  show  that, 
of  all  the  women  suffering  from  syphiHs  who  at- 
tended the  clinics  of  a  large  hospital,  seventy 
per  cent,  were  respectable  married  women  who 
had  been  infected  by  their  husbands.  He  says 
further  that  "possibly  ten  per  cent,  of  men  who 
marry  infect  their  wives  with  venereal  disease," 
and  his  estimation  of  the  total  number  of  syphil- 
itics  in  the  United  States  is  two  million. 

It  is  beheved  that,  generally  speaking,  about 
ten  per  cent,  of  all  cases  of  syphilis  are  transmitted 
accidentally  in  various  ways  like  ordinary  con- 
tagions, that  is  to  say,  not  by  sexual  contact. 
Thus,  of  887  cases  of  syphilis  in  women,  recorded 
by  Foumier,  842  had  been  acquired  in  sexual 
contact,  while  the  others  had  been  accidentally 
conveyed  by  ordinary  contact,  through  instru- 
ments, tubes,  utensils,  etc.,  or  by  caring  for  or 
suckling  diseased  infants,  etc. 


32  Hygiene  and  Morality 

The  Source  and  Spread  of  Syphilis.  A 
distinction  must  be  made  between  (a)  cause;  (b) 
source  or  breeding-place ;  (c)  mode  of  spread  of  any 
infectious  disease. 

The  cause  of  every  such  disease  is  a  special 
micro-organism.  The  sources  or  breeding-places 
where  these  organisms  flourish  and  congregate 
vary,  as  we  know,  while  the  means  by  which  they 
are  disseminated  broadcast  also  vary,  almost  to 
infinity. 

Those  contagions  that  are  called,  familiarly, 
filth  diseases,  do  not  cease  being  filth  diseases 
when  they  are  conveyed  into  clean  homes  to 
strike  down  cleanly  living  individuals.  In  the 
study  of  every  infectious  disease  knowledge  of  the 
breeding-place  or  native  haunt  of  its  germ  is  of 
the  utmost  importance  for  practical  hygiene. 
Thus  the  world  has  rung  with  the  announcements 
of  the  mosquito  carriers  of  yellow  fever  and 
malaria  and  with  the  exploits  of  those  medical 
heroes  who  sacrificed  their  lives  in  the  search  for 
this  knowledge; — again,  in  the  case  of  tuberculosis, 
information  as  to  the  breeding-places  and  modes 
of  dissemination  of  the  tubercle  bacillus  is  pub- 
lished in  public  places,  told  in  public  lectures,  and, 
indeed,  almost  cried  in  the  streets. 


Syphilis  33 

In  the  case  of  typhoid  fever,  it  is  accepted  by- 
all  intelligent  people  as  a  civic  crime  to  neglect 
water  supplies.  So  in  the  case  of  every  infectious 
germ;  as  its  habitat  and  ways  of  spreading  are 
learned,  the  knowledge  is  given  freely  and  fully 
to  the  world.  In  the  case  of  syphilis,  and  of  other 
venereal  diseases  as  well,  though  their  specific 
micro-organisms  have  not  long  been  identified, 
their  breeding-places  and  most  prominent  mode 
of  transmission  have  been  well  known  for  many 
years  by  the  medical  and  legal  professions  and 
by  sophisticated  members  of  the  laity,  but,  be- 
cause of  the  perplexing,  complicated,  and  diffi- 
cult social  web  in  which  they  were  woven,  these 
facts  have  been  concealed  and  an  absolutely 
opposite  policy  has  prevailed  from  that  followed, 
for  instance,  with  tuberculosis.  With  the  latter, 
full  publicity :  with  the  former,  until  most  recently, 
almost  unbroken  secrecy.  Every  one  talks  of 
tuberculosis;  almost  no  one  of  venereal  disease. 
It  is  true  that  tuberculosis  also  was  not  made 
a  matter  of  public,  national  importance  until  its 
ciirable,  preventable,  and  non-inheritable  nature 
was  discovered.  This  gives  hope  for  believing 
that  venereal  diseases  also  may  be  brought 
into  the  open,  since  it  can  be  shown  that  they 


34  Hygiene  and  Morality 

are  not  only  curable,  but,  more  than  any  others, 
preventable,  since  their  prevention  may  be  a 
matter  of  choice  and  of  the  individual  will.  To 
these  hopeful  facts  the  certainty  of  the  relentless 
hereditary  transmission  of  syphilis  should  act 
as  a  powerful  spur. 

Breeding-place  of  Syphilis  and  the  Vener- 
eal Diseases.  The  breeding-place  of  all  venereal 
diseases  without  exception  is  in  the  social  insti- 
tution called  prostitution,  or  sexual  promiscuity: 
in  the  debasement  and  degradation  of  what  should 
be  the  highest  and  most  revered  of  physical 
powers,  those  involved  in  the  act  of  generation. 
Bred  and  cultivated  in  prostitution,  venereal 
diseases  spread  thence  through  the  community, 
attacking  the  innocent  as  well  as  the  guilty,  the 
pure  as  well  as  the  impure,  just  as  typhoid  fever 
is  no  respecter  of  persons,  no  matter  how  strict 
their  own  personal  sanitary  standards  may  be. 

How,  or  why,  the  parasitic  powers  of  the 
SpirochcBte  pallida  first  declared  themselves  in 
unlawful,  not  in  lawful  sexual  intercourse,  is  a 
mystery.  But  it  is  certain  that  this  organism 
is  never  met  with  in  the  relation  of  mar- 
riage  unless    it    has   been    brought   from    with- 


Syphilis  35 

out.  Excesses  in  the  marriage  relation,  though 
productive  of  other  evils,  do  not  bring  on 
venereal  diseases.  If,  as  some  writers  state, 
even  polygamy  does  not  promote  them,  then 
it  would  seem  as  if  the  original  exciting  cause 
favourable  to  the  parasitic  vigour  of  the  Spiro- 
clicBte  pallida  must  have  been  in  some  way  related 
to  the  numbers  and  variety  of  male  beings  who 
practised  a  heterogeneous  promiscuity.  How- 
soever their  derivation  might  be  traced,  prostitu- 
tion is  now  as  certainly  the  abiding-place  and 
inexhaustible  source  of  this  as  of  other  germs  of 
venereal  disease,  as  the  marshy  swamp  is  the 
abode  of  the  malaria-carrying  mosquito,  or  the 
polluted  water  supply  of  the  typhoid  bacillus. 
Pontoppidan  of  Copenhagen  says:  ''Even  if 
contagion  is  carried  in  different  ways,  its  origin  can 
nearly  always  be  traced  back  to  prostitution." 
And  Bulkley  says:  ''Prostitution  undoubtedly 
stands  foremost  as  a  cause  of  syphilis  and  far 
outweighs  all  other  causes  together."  Again, 
he  says:  "In  the  enormous  majority  of  cases 
syphilis  is  acquired  in  illicit  intercourse."  Osier 
says,  "Inextricably  blended  with  it  [the  social 
evil]  is  the  prevention  of  syphilis."  Morrow 
speaks  of  "The  original  source  of  these  infections 


36  Hygiene  and  Morality 

in  that  irregular  commerce  between  the  sexes 
known  as  prostitution.'* 

Since  the  discovery  of  the  germ  of  syphilis  there 
appears  some  tendency  on  the  part  of  some  medical 
writers  to  remove  syphilis  from  the  list  of  venereal 
diseases.  As  has  been  mentioned,  it  is  frequently 
classified  separately,  thus:  "Syphilis  and  the 
Venereal  Diseases."  The  argument  is  that,  with 
the  fuller  knowledge  of  its  many  modes  of  trans- 
mission, its  constitutional  features,  and  heredita- 
bility, its  venereal  stigma  should  be  removed. 
Yet,  as,  although  a  germ  disease,  its  germ  does 
not  appear  to  be  distributed  generally,  like  the 
pus-producing  germs ;  as  the  disease  syphilis  never 
breaks  out  afresh  under  normal  conditions,  nor 
develops  from  the  germ  in  the  course  of  moral  liv- 
ing, but  is  cultivated  in  morally  unclean  sexual 
relations,  then  it  does  not  seem  incorrect  to  call 
it  a  venereal  disease,  even  though  it  may  be  com- 
municated to  moral  and  innocent  individuals  in 
non-venereal  ways  arising  in  the  ordinary  contact 
of  daily  life.  The  important  things  to  know  are: 
That  it  is  cultivated  in  prostitution  and  thence 
spread  through  the  community  in  ways  which 
are  to  be  mentioned  in  detail.  These  ways  are 
classified  by  Bulkley  as  follows : 


Syphilis  37 

I.  Inherited.     II.  Marital.     III.  Extra- genital. 

I.  The  hereditary  communicability  of  syphilis 
has  been  discussed. 

II.  The  marital  mode  of  transmission  is  the 
infection  of  one  partner  (usually  the  wife)  by  the 
other  during  the  performance  of  the  act  of  genera- 
tion. As  this  act  offers  the  most  favourable 
possible  opportunity  for  infection  of  such  a  nature 
to  be  carried,  it  results  that  by  far  the  greatest 
proportion  of  cases  that  are  innocently  or  acci- 
dentally received — a  proportion  that  is  variably 
estimated — have  been  conveyed  in  the  marriage 
relation. 

III.  With  the  knowledge  of  the  micro-organism 
and  its  presence  in  all  syphilitic  lesions  and  in  the 
discharges  from  primary  sores,  ulcers,  mucous 
patches,  secretions  of  the  mouth  and  nose,  etc., 
it  may  be  readily  understood  that  the  opportu- 
nities for  infection  to  be  conveyed  in  the  ordinary 
processes  of  daily  life,  especially  when  people  live 
under  crowded  or  uncleanly  conditions,  are  very 
numerous. 

That  syphilis  is  not  more  frequently  conveyed 
by  incidental  contact  than  is  actually  the  case  is 
due  to  the,  fortunately,  very  short  life  of  the 
germ  outside  the  human  body. 


38  Hygiene  and  Morality 

All  of  the  common  acts  of  daily  life  may  serve 
as  means  of  infection  during  the  brief  period 
of  the  parasite's  existence,  viz.,  eating  and  drink- 
ing from  cups  and  saucers,  knives,  forks,  and 
spoons  that  may  have  been  in  contact  with  the 
lips  of  a  syphilitic;  putting  pencils,  pins,  money, 
whistles,  or  any  other  article  in  the  mouth  after 
it  may  possibly  have  been  in  that  of  an  infected 
person. 

Towels,  handkerchiefs,  pillow-cases,  or  any 
article  of  bedding  as  well  as  water-closet  seats 
and  bath-tubs  may  serve  as  carriers.  Surgical 
and  dental  instruments,  shaving  apparatus,  med- 
ical appliances  in  familiar  use,  as  bulbs,  sprays, 
douche  bags,  spatulas,  and  syringes,  may  convey 
the  poison.  Cases  have  been  recorded  where  it 
has  been  inoculated  during  the  process  of  vaccina- 
tion, and  occasional  known  instances  of  this  kind 
have  had  much  to  do  with  strengthening  the 
objections  of  anti-vaccinationists  and  intensifying 
the  popular  prejudice  against  vaccination  that  is 
found  in  some  communities.  Syphilis  has  also 
been  conveyed  in  circumcision  and  other  slight 
operations. 

Laundresses  and  rag-pickers  have  not  infre- 
quently been  infected  by  soiled  or  cast-off  clothing; 


Syphilis  39 

physicians  and  surgeons  are  always  liable  to  this 
danger  in  the  course  of  their  professional  work; 
midwives  are  exposed  during  the  delivery  and 
care  of  patients;  nurses  have  been  infected  while 
caring  for  patients,  the  nature  of  whose  illness 
had  not  been  made  known  to  them,  and  with  whom 
they  were  therefore  not  as  vigilantly  on  guard 
as  they  should  have  been. 

Most  dangerous  of  all  the  avenues  of  accidental 
infection  is  contact  with  the  person  of  the  syphili- 
tic, on  account  of  the  probability  of  then  receiving 
germs  that  are  living  and  virulent.  Any  such 
contact  with  the  lips,  teeth,  or  tongue  is  es- 
pecially dangerous,  such  as  kissing  (an  act  which 
is  known  to  have  been  the  cause  of  many  innocent 
cases),  pla^rful  biting  or  mouthing  (such  as  is 
often  carried  on  playfully  between  children  and 
adults),  sucking  wounds,  licking  with  the  tongue, 
etc. 

The  syphilitic  baby  is  an  especially  infectious 
object  because  of  the  many  necessities  of  the 
baby  for  close  personal  care  and  handling  in  feeding 
and  bathing  it. 


CHAPTER  II 

gonorrhcea  and  chancroid 

/"^onorrhcea;  its  Specific  Micro-organism. 
^^  Gonorrhoea  is  caused  by  an  organism  called 
Gonococcus  gonorrhcece  which  was  discovered  by 
Neisser  in  1879  and  has  been  especially  studied 
and  described  by  Bumm.  As  it  is  usually  seen 
in  pairs,  it  is  also  called  the  Diplococcus  gon- 
orrhxcB  or  the  Micrococcus  of  Neisser.  It  is 
cultivable  with  difficulty,  and  does  not  survive 
many  transplantations,  yet  transplanting  does 
not  lessen  its  virulence.  It  is  always  found  in 
gonorrhoeal  pus,  but  is  never  found  in  other 
inflammatory  conditions  unless  these  are  of 
gonorrhoeal  origin.  It  is  said  to  perish  quickly 
in  sunlight  and  to  be  killed  in  a  few  hours  by 
drying.  Experimentation  with  it  in  the  inocu- 
lation of  animals  has  been  attended  with  special 
and  unusual  difficulties. 

The  Gonococcus  gonorrhcece  can  live  for  years, 

or  indefinitely,  in  the  human  tissues  in  a  dormant 

40 


Gonorrhoea  and  Chancroid  41 

or  latent  state,  latent  gonorrhoea  being  frequent 
in  both  men  and  women.  This  characteristic, 
imknown  until  the  day  of  bacteriological  study 
with  the  microscope,  and  not  immediately  dis- 
covered even  then,  gives  the  disease  a  specially 
uncertain  character  and  makes  it  quite  as  treacher- 
ous as  syphilis,  if  not  even  more  so. 

After  remaining  latent  for  a  long  time,  perhaps 
for  years,  the  organism  of  gonorrhoea,  if  conveyed 
to  the  sound  and  healthy  tissues  of  another  indi- 
vidual (such  tissues  being  spoken  of,  in  regard 
to  the  organism,  as  ''virgin,"  or  "sterile"  tissues), 
finds  its  most  favourable  conditions  for  growth 
and  then  excites  an  actively  acute  inflammation 
and  displays  its  utmost  virulence. 

History  of  Gonorrhoea.  Gonorrhoea  is  pri- 
marily a  genito-urinary  disease,  and  was  for- 
merly believed  to  be  a  purely  local  affection.  It 
is  supposed  to  be  as  old  as  the  human  race,  and, 
like  syphilis,  its  main  line  of  propagation  has 
always  been  in  the  promiscuous  intercourse  of 
prostitution,  whence  it  has  been  disseminated 
in  every  direction.  Ancient  writings  specify  its 
symptoms  with  enough  exactitude  to  make  its 
identity   plain.     This   identity   was   lost   in   the 


42  Hygiene  and  Morality 

epidemic  of  syphilis  in  the  15th  century,  to  which 
allusion  has  been  made.  During  the  i8th  century 
the  difference  between  syphilis  and  gonorrhoea 
might  have  been  rediscovered,  had  not  an  inexact 
experiment  of  the  celebrated  John  Hunter  caused 
the  medical  profession  to  regard  all  venereal  dis- 
eases as  one  up  to  the  time  of  the  work  of  Ricord. 
If  syphilis  has  only  been  fairly  well  understood 
for  the  last  half -century,  gonorrhoea,  at  least  in 
so  far  as  women  are  concerned,  has  only  been 
estimated  according  to  its  real  gravity  in  the 
last  decade,  though  Neisser  made  his  discovery 
in  1879.  In  1857  two  medical  writers,  Bernitz 
and  Goupil,  had  made  studies  of  gonorrhoeal  in- 
fection of  the  Fallopian  tubes,  but  had  found  no 
followers.  In  1 878  Noeggerath  sounded  a  warning, 
declaring  that  individuals  with  gonorrhoea  could 
remain  infectious  during  a  lifetime,  but  he  was 
regarded  as  an  alarmist  and  his  statistics  of  the 
frequency  of  gonorrhoea  in  married  men  as  ex- 
aggerations. Gonorrhoea  had  been  regarded  as 
an  ordinary  *' catarrhal"  inflammation  of  the 
mucous  membrane,  locating  itself  usually  in  the 
urethra,  and  as,  in  men,  the  disease  was  well 
known  to  be  acquired  in  promiscuous  sex  relations, 
it  was  commonly  regarded  with  indifference,  or 


Gonorrhoea  and  Chancroid  43 

even  with  levity,  as  a  proof  of  rakishness,  the 
purulent  discharge  being  colloquially  described 
in  military  countries  as  the  "goutte  militaire." 

In  the  light  of  modem  knowledge  of  the  dis- 
astrous part  taken  by  the  gonococcus  of  gonorrhoea 
in  that  sad  array  of  obscure  and  unnecessary  ail- 
ments which  have  been  erroneously  called  "Dis- 
eases of  Women,"  the  traces  of  this  levity  make 
painful  reading,  found,  as  they  are,  even  in 
medical  writings  of  a  generation  ago  or  less. 
To-day,  instead  of  being  regarded  as  a  local 
disease,  gonorrhoea  also,  like  syphilis,  is  known 
to  develop  constitutional  disturbances  of  a  serious 
and  chronic  nature,  and  suggestions  are  not 
wanting  that  the  former  point  of  view  will  soon  be 
antiquated. 

Course  and  Symptoms  of  Gonorrhoea.    Osier 

divides  the  course  of  gonorrhoea  into  three 
stages : 

1.  Primary  infection. 

2.  Extension  through  the  entire  genito-urinary 
tract. 

3.  Systemic  infection. 

Primary  Infection.  The  period  of  infection 
is  from  twelve  hours  to  a  week  or  more,  the  average 


44  Hygiene  and  Morality 

being  one  or  two  days.  In  adults  the  urethra 
is  usually  the  point  of  infection,  or,  in  women,  it 
may  be  also  the  cervix  uteri,  for  the  reason  that  the 
delicate  linings  of  these  parts  are  only  weakly 
resistant  and  are  easily  penetrated  by  the  bacillus. 
The  uninjured  squamous  epithelium  of  the  adult 
is  not  easily  infected.  With  little  girls,  infection 
usually  attacks  the  vulva  and  vagina,  by  reason 
of  their  delicate  structure  in  childhood. 

The  symptoms  of  the  primary  stage  are  those 
of  an  ordinary  acute  local  infection,  with  itching 
and  burning  of  the  parts,  redness  and  swelling, 
pains,  often  intense,  on  urination,  and  a  discharge, 
first  mucous  and  finally  purulent,  with  oedema 
of  the  surrounding  tissues,  excoriations,  multiple 
abscesses,  and  perhaps  hemorrhage  from  swollen 
papillae.  To  the  eye  there  is  nothing  to  distin- 
guish the  symptoms  from  those  of  an  ordinary- 
inflammation,  and  only  the  microscope  makes  the 
diagnosis  positive.  Formerly,  it  was  believed  that 
cure  had  taken  place  when  the  discharge  ceased. 
It  is  now  known  that  this  is  far  from  being  the 
case. 

Second  Stage.  The  inflammation  now  goes 
on  and  involves  the  organs  of  generation  and 
the    urinary    tract,    ascending    the   ureters    and. 


Gonorrhoea  and  Chancroid  45 

spreading,  it  may  be,  to  the  kidneys,  where  it  may 
produce  a  fatal  pyelitis.  In  women  a  large 
proportion  of  all  cases  of  cystitis,  salpingitis, 
metritis,  ovaritis,  and  pelvic  peritonitis,  as  well 
as  many  cases  of  infection  after  childbirth  are 
caused  by  the  gonococcus. 

The  most  serious,  because  irreparable,  action  of 
gonorrhoea  upon  the  organs  of  generation  is  to 
cause  sterility  in  both  men  and  women.  The 
frequency  with  which  this  sequel  occurs  will  be 
referred  to  under  ''Statistics."  In  women  this 
sterility  is  sometimes  brought  about  by  occlusion 
or  blocking  of  the  Fallopian  tubes.  Again,  there 
is  what  is  called  ''one-child  sterility."  When 
this  happens,  the  gonococcus,  at  first  restricted  in 
its  location  to  the  cervix  uteri,  is  enabled  owing 
to  the  relaxation  of  the  parts  after  childbirth,  to 
extend  to  the  tubes  and  ovaries.  Or,  again,  the 
necessity  of  complete  operative  removal  of  all 
the  female  organs  of  generation  effectually  puts  an 
end  to  all  expectations  of  maternity. 

The  Destruction  of  Eyesight.  Calamitous 
as  are  the  sequels  of  gonorrhoea  to  the  adult, 
especially  to  the  married  woman,  no  other  single 
effect  wrought  by  it  can  compare  with  the  tragedy 


46  Hygiene  and  Morality 

of  infants,  blinded  at  birth  by  virulent  gonorrhoeal 
poison,  which  enters  the  eyes  during  the  infant's 
passage  through  the  vaginal  canal.  This,  too, 
will  be  referred  to  under  "Statistics."  Gonor- 
rhoea! poison  is  most  actively  destructive  of  the 
cornea,  and  the  danger  of  incurring  blindness 
from  having  the  eyes  infected  with  pus  or  dis- 
charge containing  this  virus  is  equally  as  great 
for  adults  as  for  infants.  The  opportunity  for 
infection  is  less,  yet  blindness  of  older  children 
and  adults  from  the  gonococcus  received  from 
towels,  sheets  and  pillow-cases,  fingers,  hand- 
kerchiefs, etc.,  is  frequent,  and  cases  have  occurred 
where  nurses  have  lost  one  or  both  eyes  through 
lack  of  sufficient  precautions. 

Third  Stage.  The  constitutional  forms  of 
gonorrhoea  include,  besides  disease  of  the  kidneys 
already  mentioned,  gonorrhoeal  arthritis,  an 
intractable  and  obstinate  form  of  rheumatism, 
prone  to  relapses,  and  gonorrhoeal  endocarditis. 
These  are  regarded  as  its  two  most  serious  consti- 
tutional sequels.  There  is  also  a  gonorrhoeal 
septicaemia.  Authorities  mention  a  urogenital  tu- 
berculosis, to  which  chronic  urethritis  has  the  re- 
lation of  a  predisposing  cause.     Morrow  speaks  of 


Gonorrhoea  and  Chancroid  47 

this  as  a  recent  acquisition  of  knowledge,  and 
adds  that  modern  investigations  are  showing 
that  it  is  possible  for  the  gonococcus  to  be  taken 
up  by  the  blood  and  lymph  and  carried  to  all 
organs  of  the  body,  and  that  it  may  affect  them 
all  injuriously.  It  has  been  found  in  the  brain 
and  cord,  the  pleura,  the  liver,  spleen,  and  kidneys, 
the  endocardiimi,  the  sheaths  of  tendons  and  of 
joints,  and  in  the  periosteum.  Finally,  it  may 
not  be  amiss  to  place  imder  the  constitutional 
effects  of  the  gonococcus  that  innumerable  army 
of  chronically  semi-invalided  married  women  of 
all  ages,  who,  without  having  clearly  defined  loss 
of  health,  "have  never  been  well  since  married," 
whose  whole  existence  is  a  drag  and  who  have  often 
failed  to  find  the  commiseration  due  them,  this 
having  indeed  been  oftener  given  to  the  husbands, 
whose  lot  in  having  ailing  wives  was  all  unknow- 
ingly due,  in  many  cases,  to  their  own  transmission 
to  these  imsuspecting  and  imf  ortunate  women  of 
the  deadly  gonococcus  of  Neisser. 

Modes  of  Transmission.  Though  in  the 
majority  of  cases  the  germ  is  conveyed  during 
the  act  of  coitus,  it  is  also  possible  for  it  to  be 
carried  in  the  contact  of  daily  life,  and  it  is  only 


48  Hygiene  and  Morality 

the  brevity  of  its  existence  after  being  dried  that 
saves  many  cases  from  infection.  Infection  from 
unclean  water-closet  seats  is  frequent,  instances 
having  been  known  where  a  whole  series  of 
cases  of  vulvo-vaginitis  have  arisen  from  this 
cause.  It  is  pointed  out  by  medical  writers  that 
it  is  not  necessary  to  conclude  that  little  girls 
with  a  gonorrhoeal  discharge  have  been  violated 
or  addicted  to  bad  practices  (though  such  may 
have  been  the  case)  as  it  is  quite  possible  for  them 
to  have  contracted  the  disease  from  badly  kept 
school  closets,  or  from  sleeping  in  the  same 
bed  and  being  contaminated  by  the  sheets  or 
clothing  of  diseased  persons.  Family  towels 
under  such  circumstances  are  sources  of  danger, 
and  public  baths  and  tubs  are  also  known  to 
have  been  media  of  contagion. 

Immunity  and  Anti-Serum  Treatment.  It 
is  not  believed  that  there  is  immunity  against 
the  gonococcus.  Serum  treatment  has  been  tried 
in  certain  forms  of  constitutional  disease,  and 
beneficial  results  have  been  claimed  in  the  case  of 
rheimiatism.  The  Lister  Institute  prepares  an 
"Anti-gonococcus Vaccine,"  which  is  a  preparation 
of  dead  gonococci  that  is  said  to  be  poisonous 


Gonorrhoea  and  Chancroid         49 

to  the  living  germ.*  It  is  probably  too  early 
to  find  anything  quite  authoritative  upon  this 
line  of  study. 

The  statistics  of  gonorrhoea  are  so  startling  as 
to  seem  almost  incredible.  Like  those  of  syphilis, 
they  are  drawn  from  the  records  of  hospitals  and 
medical  practitioners,  as  health  boards  ignore  the 
existence  of  venereal  diseases. 

Prevalence  of  Gonorrhcea.  Morrow  quotes 
Neisser  to  the  effect  that  gonorrhcea  is  the  most 
widespread  and  universal  of  diseases  in  the 
adult  male.  European  records  indicate  that 
about  seventy-five  per  cent,  of  all  men  have 
gonorrhoea. 

Assuming  that  a  somewhat  better  moral  stand- 
ard prevails  in  the  United  States,  it  is  given  as 
a  conservative  estimate  that  the  prevalence  of 
both  gonorrhoea  and  syphilis  among  men  is  at 
least  sixty  per  cent.  Morrow  says  that  it  is  im- 
possible to  estimate  accurately  the  extent  to  which 
gonorrhoea  is  conveyed  to  wives  in  marriage,  but 
that  it  is  generally  agreed  that  this  is  greater  than 
is  generally  suspected.  Statistics  gathered  in  New 
York  City  by  the  Committee  of  Seven  indicated 

»  British  Medical  Journal,  Feb.  27,  1909. 
4 


50  Hygiene  and  Morality 

that  nearly  thirty  per  cent,  of  all  venereal  diseases 
of  women  in  that  city  had  been  transmitted  in 
marriage  by  the  husbands.  The  remainder  (leav- 
ing out  hereditary  transmission  and  accidental 
infection)  would  probably  be  found  among  pros- 
titutes. As  to  these  unfortunate  centres  of 
infection,  J.  Taber  Johnson  estimates,  conserva- 
tively, that  at  least  thirty  per  cent,  of  their  whole 
mortality  is  due  to  gonorrhoea. 

Sterility.  Neisser  regards  gonorrhoea  as  re- 
sponsible for  more  than  forty -five  per  cent,  of  sterile 
marriages,  while  Morrow  points  out  that  these 
figures  refer  to  primary,  not  to  secondary  sterility, 
which  is  additional.  Gonorrhoea  is  the  foremost 
cause  of  male  sterility.  One  specialist  found 
thirty  cases  of  male  sterility  in  ninety-six  sterile 
marriages,  while  the  statement  is  made  by  Morrow 
that  men  are  ultimately  responsible  for  from  fifty 
to  seventy-five  per  cent,  of  all  sterility  in  married 
life.  In  from  twenty  to  twenty-five  per  cent,  of 
such  cases,  the  husband  is  sterile.  In  the  others, 
he  has  infected  the  wife,  making  her  sterile. 

The  extent  of  secondary  sterility  is  not  known. 
A  major  share,  then,  of  all  sterility  is  to  be  laid 
at  the  door  of  the  gonococcus. 


Gonorrhoea  and  Chancroid  51 

Diseases  of  Women.  The  responsibility  of 
the  gonococcus  in  causing  these  diseases  is  vari- 
ably estimated  by  different  surgeons,  ranging 
from  forty  to  eighty  per  cent.  All  cases  of 
pus  in  the  Fallopian  tubes  are  gonorrhceal,  while 
at  least  fifty  per  cent,  of  all  gynaecological  opera- 
tions are  necessita  ed  by  the  gonococcus.  This  is  a 
conservative  estimate,  some  gynsecologists  giving 
figures  from  their  own  practice  that  are  much 
higher. 

Blindness.  Eighty  per  cent,  of  all  the  puru- 
lent ophthalmia  of  infants  is  gonorrhceal,  and  from 
fifteen  to  twenty-five  per  cent,  of  all  the  blindness 
in  America  is  due  to  the  same  cause.  Neisser 
says  that  Germany  alone  has  30,000  blind  persons 
whose  affliction  was  caused  by  gonorrhceal  pus, 
while  in  Paris  the  institutions  for  the  blind  show 
that  forty-five  per  cent,  of  the  cases  have  been 
due  to  this  infection. 

Summary  of  Syphilis  and  Gonorrhcea.    The 

consensus  of  expert  medical  opinion  is,  that,  as 
a  depopulating  factor,  gonorrhoea  is  more  formid- 
able than  syphilis,  and  that  it  is  also  more  perilous 


52  Hygiene  and  Morality 

to  the  wife.  Syphilis  is  more  destructive  to  the 
life  of  offspring;  gonorrhoea  more  destructive 
to  the  female  organs  of  generation  and  to  the 
general  health.  The  hereditary  quality  and  slow 
development  of  syphilis  constitute  its  chief  terrors, 
but  the  treacherous  nature  and  persistent  vitality 
of  the  gonococcus  make  gonorrhoea  almost,  if  not 
quite,  as  terrible.  Syphilis  is,  as  a  rule,  more 
curable.  The  prognosis  of  gonorrhoea  is  always 
most  uncertain.  Both  show  certain  types  which 
are  believed  to  be  incurable. 

Taking  them  together,  they  seem  to  exhibit  the 
true  race  suicide,  and  both,  says  Taber  Johnson, 
are  intimately  connected  with  the  degeneration 
of  races  and  the  downfall  of  nations.  Grandin 
says:  *'Man,  largely  through  ignorance  of  the 
calamities  following  the  misuse  of  this  [the  re- 
productive] instinct,  has  converted  it  into  one 
for  the  extermination  of  the  species." 

Chancroid  (Venereal  Sore;  Soft  Chancre  J. 
The  identity  of  the  specific  micro-organism  of  this 
last  of  the  venereal  diseases  is  still  uncertain.  A 
strepto-bacillus  called  the  bacillus  of  Ducrey  has 
been  demonstrated  in  the  soft  chancre  but  it 
has  not  been  proved  to  be  its  sole  or  specific  cause. 


Gonorrhoea  and  Chancroid  53 

Clinically,  Bassereau,  in  1856,  determined  that 
chancroid  and  syphilis  were  not  the  same.  Never- 
theless mistakes  in  confusing  the  two  were  fre- 
quently made  until  the  organism  of  syphilis  was 
discovered. 

Venereal  sore  is  by  far  the  simplest  and  least 
dangerous  of  the  three  diseases  under  considera- 
tion. If  treated  promptly  it  is  readily  curable, 
though,  if  neglected,  serious  complications  may 
ensue  and  cure  be  a  more  difficult  matter.  The 
incubation  period  is  short;  from  several  hours  to 
several  days.  The  first  manifestation  is  a  small 
nodule  which  proceeds  rapidly  toward  suppuration, 
forming  a  painful  ulcer  with  an  intensely  infectious 
discharge.  The  ulcer  is  deep  and  irregular,  and 
its  tendency  is  to  spread  and  become  multiple. 
Herein  lies  the  danger  of  complications.  Neg- 
lected ulcers  may  involve  the  glands  and  other 
parts  in  their  vicinity  with  much  consequent 
destruction  of  tissues  locally,  but  the  disease 
has  no  constitutional  complications,  nor  has  it/ 
sequels  or  belated  manifestations.  If  properly 
treated  from  the  outset,  from  four  to  six  weeks 
suffice  for  cure.     It  only  runs  a  prolonged  course 

when  neglected. 

Venereal  sore  is  always  located  on  the  genitalia. 


SOURCES  OF  MATERIAL  USED  IN  THE  PRE- 
PARATION OF  PART  I 

Bloch,  Ivan,  Der  Ursprung  der  Syphilis.     Jena,  1901. 
Bolduan,  Charles  Frederick,  M.D.,  Immune  Sera  (Appendix 

A:  Serum  Diagnosis  of  Syphilis).     New  York,  1908. 
Bulkley,  L.  D.,  M.D.,  Syphilis  in  the  Innocent.    New  York, 

1894. 
Bull,  Ophthalmia  Neonatorum  and  its  Prophylaxis.    In  New 

York  Medical  Journal,  May  15,  1909. 
Findlay,  Palmer,  M.D.,  Gonorrhoea  in  Women.     1908. 
Forel,  August,  M.D.,  Alcohol  and  Questions  of  Sex.     In  Re- 
port of  the  International  Congress  against  Alcohol.    1905. 
Forel,  August,  M.D.,  Alkohol  und  venerische  Krankheiten. 

In  Report  of  the  International  Congress  against  Alcohol, 

1901. 
Fournier,  Alfred,  Syphilis  et  Mariage.     Paris,  1890/ 
Fournier,  Alfred,  Traite  de  la  Syphilis.     1903. 
Francke,  Hermann,  M.D.,  Beitrag  zur  Entwickelung  bosarti- 

ger  Geschwulste  auf  dem  Boden  alter  Syphilitischer  Nar- 

ben.     Wiirzburg,  1894. 
Horaud,  Ren6  Denis,  M.D.,  Syphilis  et  Cancer.      Lyon,  1907. 
Johnson,  J.  Taber,  M.D.,  The  Influence  of  Gonorrhoea  as  a 

Factor  in  Depopulation.     In  Journal  of  the  American 

Medical  Association,  August  10,  1907. 
Metchnikoff,    Elie,    The    Microbiology   of    Syphilis.     In    A 

System  of  Syphilis.     Edited  by  D'Arcy  Power  and  J. 

Keogh  Murphy.     London,  1908. 
Morrow,  Prince  A.,  M.D.,  Gonorrhoeae  Insontium,  especially 

in  Relation  to  Marriage.     In  New  York  Medical  Journal, 

June  27  and  July  4,  1903. 
Morrow,  Prince  A.,  M.D.,  Prognosis  and  Relation  of  Syphilis 

54 


Sources  of  Material  Used  55 

to  Marriage  and  Heredity.     In  Medical  News,  Sept.  2, 

1907. 
Morrow,   Prince  A.,   M.D.,   Social  Diseases  and  Marriage. 

New  York,  1905. 
Mott,  Syphilis.     In  British  Medical  Journal,  Feb.  27,  1909. 
Noeggerath,  Emil,  AI.D.,  Die  latenteGonorrhoe  im  weiblichen 

Geschlecht.     Tr.  Amer.  Gyn.  Soc.  I.     1876. 
Osier,  William,  M.D.,  Practice  of  Medicine.     [Syphilis  and 

Gonorrhoea.]    London  and  New  York,  1909. 
Pontoppidan,   Erik,    M.D.,   What   Venereal   Diseases   Mean 

and  How  to  Prevent  Them.     Translated  by  W.  Jessen. 
Ravogli,    Syphilis    in    Relation    to    Crime.     In    Ohio    State 

Medical  Journal,  August,  1906. 
Rogers  and  Torrey,  The  Treatment  of  Gonorrhoeal  Infection 

by  a  Specific  Antitoxin.     In  Journal  of  the  American 

Medical  Association,  Sept.  14,  1907. 
System  of  Medicine,  A.     [Syphilis,  etc.]     Edited  by  Allbutt. 

London,  1906. 
System  of  Syphilis,  A.     [Several  Authors.]    Edited  by  D'Arcy 

Power  and  J.  Keogh  Murphy.     London,  1906. 
Taylor,   Prognosis  in  Syphilis.    In   Medical  News,  Sept.   2, 

1907. 
Torrey,  An  Antigonococcus  Serum.     In  Journal  of  the  Ameri- 
can Medical  Association,  Jan.  2"]^  1906. 


Part  IL     Prostitution 


57 


CHAPTER  I 

CONTROL  AND  REGULATION  OF  PROSTITUTION 

T^HERE  is  a  long  and  revolting  history  of  the 
■■•  spasmodic  attempts  made  from  time  to  time 
during  the  past  ages  to  control  or  punish  prostitu- 
tion. These  attempts  usualty  took  the  form 
of  grotesque  and  brutal  punishments  for  women, 
rarely  for  men.  As  a  rule,  the  vicious  male 
seems  to  have  been  overlooked  or  regarded  as  an 
insignificant  factor  in  the  problem.  Punishments 
meted  out  to  the  woman  were  chiefly  hypocritical 
or  vindictive,  not  in  the  least  preventive.  Some- 
times she  was  put  into  an  iron  cage  and  dipped 
into  the  river, — almost  but  not  quite  drowned; 
sometimes  her  nose  was  cut  off ;  or  she  was  whipped 
or  compelled  to  w^ear  a  distinguishing  dress. 
She  has  always  been  the  victim  of  blackmail, 
and  the  methods  by  which  this  has  been  levied 
show  a  remarkable  similarity  right  down  through 
the   ages   to   modem   times:   they  were  usually 

59 


6o  Hygiene  and  Morality 

the  enactment  of  non-preventive  legislation,  of 
a  petty  and  harassing  character,  with  the  im- 
position of  heavy  fines  for  breach  of  observance. 
As  such  legislation  simply  made  it  more  difficult 
for  her  to  earn  her  bread  in  the  only  way  open  to 
her,  it  of  course  had  to  be  violated,  and  the  fines 
collected  were  divided  between  the  accuser  and 
the  city  government.  Perhaps  this  mode  of  profit- 
sharing  is  not  yet  obsolete.  It  is  needless  to  give 
much  time  to  the  painful  details  of  centuries 
that  are  gone,  and  it  will  suffice  to  state  simply 
that  all  such  legislation  rested,  as  it  still  does, 
on  the  acceptance  (once  unquestioned,  but  to- 
day no  longer  so)  of  the  double  standard  of 
morals. 

The  Double  Moral  Standard.  The  essential 
feature  of  the  double  code  or  standard  of  morals 
is  the  entire  absence  of  logical  sequence.  There- 
from results  the  injustice  which  is  so  strik- 
ing, both  from  the  standpoint  of  reason  and  of 
humanity. 

The  double  standard  tacitly  permits  men  to  in- 
dulge freely  and  unchecked  in  sexual  irregularity 
without  consequent  loss  of  social  standing,  but  it 
dooms  the  women  who  are  necessarily  involved 


Control  of  Prostitution  6i 

in  these  irregularities  to  social  ostracism  and 
even  to  complete  degradation. 

In  order  to  justify  immoral  practices  among 
themselves  and  to  have  a  plausible  explanation 
ready  if  criticism  offered,  the  doctrine  of  "physical 
necessity"  has  been  invented  for  men  by  them- 
selves, and  has  even  been  fortified  by  the  positive 
teachings  of  prominent  medical  men.  This  doc- 
trine, however,  has  never  been  extended  to  women, 
but,  instead,  the  cowardly  and  cruel  theory  of  in- 
nate depravity  has  been  industriously  dissemi- 
nated as  applying  to  "fallen  women,"  thus 
skilfully  ensuring  an  isolated  position  for  these 
unfortunates,  and  effectually  checking  the  out- 
growth of  pity  for  them  among  women  of  the 
protected  classes.  The  practical  resiilts  of  this 
psychological  jugglery  have  been,  that,  of  two 
partners  in  one  and  the  same  act,  neither  one  of 
whom  could  execute  this  act  alone,  and  with 
whom,  if  the  element  of  compulsion  entered  as  a 
complication,  it  could  not  possibly  be  present 
in  the  case  of  the  stronger  partner, — men,  the 
stronger,  have  remained  free  from  blame ;  women, 
the  weaker,  have  lived  under  a  curse. 

The  fact  that  this  way  of  regarding  the  woman 
concerned  disproves  the  argument  of  "physical 


62  Hygiene  and  Morality- 

necessity"  is  only  a  part  of  the  illogicality  of  the 
whole.  It  is  evident  that,  if  unregulated  sexual 
practice  were  really  necessary  for  men,  there 
could  be  no  element  of  shame  or  wrong  in  it,  and 
there  could  therefore,  obviously,  be  none  for  the 
women,  for  no  act  that  is  physically  necessary  is 
wrong,  no  matter  how  primal  it  may  be. 

In  order  to  give  strength  to  the  social  structure 
of  prostitution,  certain  catch  phrases  have  been 
passed  current  to  act  as  mental  hypnotics.  For 
instance:  "  Prostitution  must  always  exist,  because 
it  always  has  existed.  Because  it  always  has 
existed,  therefore  it  always  must  exist."  But  it 
will  be  seen  that,  in  company  with  this  dictum, 
there  have  always  gone  very  definite  social  and 
legal  contrivances  for  ensuring  its  existence. 

Modern  Systems  of  Regulation.  In  spite  of 
the  hitherto  generally  accepted  belief  in  the  neces- 
sity and  right  of  men  to  practise  sexual  irregularity, 
the  presence  of  prostitution  in  the  community, 
though  the  inevitable  result  of  such  practice,  has 
been  regarded  as  a  "social  evil,"  partly  because  of 
its  accompaniment  of  disease.  In  order  to  minimise 
the  danger  of  disease  while  maintaining  prostitu- 
tion, associations  of  men  have,  in  the  past,  set 


Control  of  Prostitution  63 

themselves  to  the  task  of  making  vice  safe,  by 
establishing  systems  of  "  Regulation"  with  medical 
inspection  of  female  prostitutes.  This  device 
originated,  it  is  said,  with  Napoleon  Bonaparte, 
who  thought  it  proper  that  women  should  be 
sacrificed  to  his  soldiers,  but  did  not  wish  the 
soldiers  to  be  invalided.  Since  his  day,  regulatory 
systems  have  been  established  in  most  European 
countries.  They  vary  somewhat  in  detail,  and 
have  been  roughly  divided  into  three  types: 
the  Scandinavian,  the  simplest  and  the  most  free 
from  obnoxious  features,  combining  a  certain 
amount  of  police  supervision  with  the  compulsory 
reporting  of  venereal  diseases  and  ample  free 
medical  service  without  a  stigma  attached  to  it; 
the  German,  sometimes  called  Neisser's  system, 
highly  complicated,  with  some  slight  attempt 
at  more  logic  than  is  foimd  in  the  third,  called 
the  unilateral  system,  and  which  has  been  adopted 
in  many  foreign  countries,  having  reached  its  most 
notorious  development  in  France,  where,  in  the 
main,  it  is  still  in  force,  though  it  is  probable  that 
its  downfall  is  near. 

Opposed  alike  to  all  systems  of  state  or 
police  regulation  of  prostitution  are  the  principles 
of  the  abolitionists,  to  be  discussed  later,  and 


64  Hygiene  and  Morality 

of  the  most  modem  and    wisest    socio-medical 
teachers. 

The  organisation  of  the  unilateral  system  was 
as  follows:  A  special  department  of  poHce, 
called  Morals  Police  {Police  des  Mceurs),  was 
authorised  to  regulate  and  control  prostitution 
as,  in  general,  the  head  of  the  department  saw 
fit ;  that  is,  ordinarily  no  public  legislation  defined 
their  powers,  but  these  were  defined  in  police 
codes  and  in  municipal  ordinances.  At  the 
very  outset,  therefore,  the  women  thus  dealt 
with  were  excluded  from  the  realm  of  the  common 
law.  The  police  had  full  power  to  arrest  any 
women  whom  they  might  "believe"  or  ''suspect," 
or  "have  reason  to  think"  were  immoral.  This 
part  of  their  powers  rested  chiefly  upon  a  spy 
system  of  plain-clothes  men,  and  anonymous 
letters  were  regarded  as  valuable  sources  of 
information.  Arrest  was  followed  by  forcible 
medical  examination,  and  the  woman's  name  and 
address  were  inscribed  on  the  lists  in  the  police  de- 
partment. Every  two  weeks,  or  at  other  spec- 
ified times,  she  was  compelled  to  appear  for 
examination,  and,  if  found  diseased,  was  confined 
in  what  was  essentially  a  hospital  prison. 
<   The  one-time  head  of  the  Morals  Police  of 


Control  of  Prostitution  65 

Paris,  when  asked  wherein  lay  the  chief  strength 
of  his  system,  repHed:  "Arrests;  always  arrests; 
more  and  more  arrests;  that  is  our  only  hope." 

That  innocent  women  were  often  subjected  to 
arrest  and  even  imprisonment  under  this  system 
was  regarded  as  an  unavoidable  incident. 

The  unfortunates  under  police  surveillance 
could  never  hope  to  escape  from  their  life. 
Hounded  by  the  police  wherever  they  went,  their 
outlook  was  described  by  Dr.  Mireur,  a  defender 
of  the  system,  in  these  words : 

Cut  off,  not  only  from  society  hut  from  heaven;  from 
hope,  and  from  the  power  to  repent;  nevertheless 
[he  added]  inscription  and  licensing  are  essential, 
indispensable,  even  as  prostitution  itself. 

All  systems  of  regulation  alike  brought  into 
existence  the  licensed  or  "tolerated"  houses  of 
ill-fame,  and  such  houses  were  protected  by  the 
police.  Their  keepers  possessed  a  certain  status 
by  reason  of  this  connection,  and  the  appearance 
of  recognition  and  support  by  the  government 
confused  the  moral  sense  of  the  people.  The 
keepers  of  such  places  have  alw^ays  been  active 
supporters  of  regulative  acts,  because  the  women 
are  then  more  completely  helpless.     A  German 


66  Hygiene  and  Morality 

chief  of  police  admitted  in  his  reports  that  the 
inscription  of  prostitutes  by  the  pohce  aggravated 
their  abject  condition  in  a  horrible  manner,  while 
a  member  of  the  Reichstag  once  said:  "It  is  well 
known  that  these  are  marked  women  and  can 
never  reform." 

Such  is  the  system,  which,  with  varying  modi- 
fications and  with  some  differences  of  detail 
as  to  the  harshness  with  which  it  has  been  or  is 
enforced,  still  prevails  widely  under  the  general 
term,  *' The  Continental  System  of  the  Regulation 
of  Vice."  It  has  recently  been  discarded  in  Italy, 
and  has  been  strongly  condemned  by  public 
commissions  in  France.  Switzerland  has  given 
it  up,  except  in  Geneva,  where  it  is  in  force  in 
full  ignominy. 

It  seems  almost  incredible  that  there  are  many 
who  would  willingly  see  this  system  implanted  in 
the  United  States.  More  than  one  attempt  has 
been  made  to  introduce  it  into  this  country,  and 
arguments  in  its  favour  are  not  infrequently 
heard.  It  is  for  this  reason,  among  others,  that 
women  should  be  informed  and  alert  upon  a  sub- 
ject which  would  otherwise  seem  too  horrible  to 
contemplate. 

The  continental  system  of  licensed  houses  of 


Control  of  Prostitution  67 

ill-fame,  as  will  be  seen  in  a  later  chapter,  has 
been  the  breeder  for  the  white  slave  traffic,  and 
these  houses  have  been  the  main  market  of  the 
traders  and  have  afforded  the  trade  its  security. 
The  unfortunate  women  hate  the  hcensed  houses 
because  of  their  tyrannous  features,  and  it  has 
never  been  easy  to  fill  the  vacancies  caused  by 
disease  and  death.  An  organised  system  of 
supply  and  demand  has  therefore  grown  up, 
having  developed  early  in  the  19th  century,  not 
very  long  after  the  establishment  of  the  regulation 
system.  It  must  be  explained  that  no  govern- 
ment has  ever  consciously  encouraged  a  white 
slave  trade,  but  this  has  been  the  logical  though 
unforeseen  result  of  giving  the  tolerated  houses  a 
recognised  status. 

The  Introduction  of  State  Regulation  into 
Great  Britain.  The  strongest  bulwark  of  regu- 
lated vice  in  all  countries  has  been  the  military 
element.  It  has  been  a  generally  accepted  under- 
standing that  armies  of  men  must  have  free 
access  to  abandoned  women,  and  it  has  always 
been  a  subject  of  serious  concern  with  authorities 
to  make  this  vice  as  safe  as  possible,  in  order  that 
the    fighting    strength    of    regiments    might    be 


68  Hygiene  and  Morality 

maintained  in  its  efficiency.  The  necessary  sac- 
rifice of  women  involved  in  this  point  of  view 
brought  forth  no  protests,  even  from  women,  until 
the  women  of  England  were  aroused  to  it  by  an 
attempt  made  to  force  the  continental  system  upon 
that  country. 

The  Contagious  Diseases  Acts.  Early  in 
the  19th  century  the  military  hierarchy  had 
been  desirous  of  establishing  a  regulated  system 
in  England,  but  the  time  did  not  seem  propitious 
until  well  along  in  the  mid-century,  when  the 
purpose  crystallised. 

A  woman  sounded  the  first  warning.  Harriet 
Martineau,  with  her  finger  always  on  the  political 
pulse,  foresaw  the  coming  danger,  and  wrote 
several  powerful  letters  of  protest  to  the  Daily 
News  in  1859.  I^  i860  a  Committee  of  the  House 
of  Lords  sat  to  consider  the  advisability  of  intro- 
ducing compulsory  acts  into  India.  Miss  Martin- 
eau, in  her  autobiography,  says  that  Florence 
Nightingale  was  called  to  give  her  opinion,  and 
spoke  strongly,  with  positive  testimony  against  it. 
Nevertheless,  between  1864  and  1869,  the  sys- 
tem was  established  in  Great  Britain  by  a  series  of 
Acts  of  Parliament  passed  with  such  haste  and 


Control  of  Prostitution  69 

secrecy  that,  as  is  authoritatively  stated  in  many 
published  sources  of  reference,  only  about  one 
tenth  of  the  members  knew  of  them.  Introduced 
in  late  night  sessions  and  rushed  through  with  sur- 
reptitious haste,  the  first  and  second  were  only 
entering  wedges,  but  the  third  established  the  full 
programme  of  regulation  for  all  garrison  towns  and 
within  a  radius  of  fifteen  miles  around  each  one. 

The  first  to  give  publicity  to  the  new  legislation, 
which  was  enforced  with  great  secrecy,  was  the 
head  of  a  Home  for  Girls,  Daniel  Cooper,  who 
first  suspected  the  onset  of  something  new  and 
menacing,  and  finally  succeeded  in  obtaining  a 
copy  of  the  Acts.  He  exposed  their  iniquity, 
and  was  supported  by  two  physicians,  Dr.  Charles 
Bell  Taylor  and  Dr.  Worth,  who  denounced 
them  vigorously.  But  no  headway  was  made 
in  opposing  them  until  all  the  moral  forces  of 
England  were  finally  united  under  the  leadership 
of  Mrs.  Josephine  E.  Butler, — one  of  the  rare 
characters  of  the  world,  a  perfect  example  of  the 
exalted  and  fearless  type  of  ideal  womanhood; — 
one  whose  maternal  protectiveness  extended  to 
every  young  and  helpless  creature. 

Scope  of  the  Acts.  The  Acts  empowered 
policemen  in  plain  clothes,  acting  as  spies,  to  arrest 


^o  Hygiene  and  Morality 

any  woman  in  the  territory  covered  by  the  law. 
The  police  were  only  obliged  to  ''declare"  that 
they  "had  reason  for  believing"  the  women  to 
be  immoral;  it  was  therefore  impossible  to  punish 
them  for  arresting  innocent  women,  nor  could 
informers  be  punished.  Women  thus  arrested 
were  requested  to  sign  a  paper  called  a  ''voluntary 
submission"  (and  ignorant  ones  were  easily 
coerced  into  it)  promising  to  present  themselves 
at  the  periods  ordered  for  medical  examination, 
and,  as  an  alternative,  they  had  to  defend  their 
reputations  in  court.  If  they  refused  to  submit 
to  the  medical  examination,  they  could  be  sent 
to  prison  for  disobedience.  If,  when  examined, 
they  were  found  to  be  diseased,  they  were  com- 
mitted to  a  hospital  prison  for  compulsory  treat- 
ment. If  resistant,  they  were  taken  there  by 
the  police,  and  if  they  left  it  before  being  dis- 
charged they  were  liable  to  imprisonment  with 
hard  labour  for  one  or  two  months.  Under  such 
a  law,  as  an  English  writer  pointed  out,  the  police 
spies,  acting  on  hints  given  them  by  persons  acting 
in  jealousy  or  revenge,  or  from  motives  of  black- 
mail, "held  the  honour  and  reputation  of  every 
woman  among  the  poorer  classes  absolutely  at  their 
disposal." 


Control  of  Prostitution  71 

Mrs.  Butler's  Crusade.  The  women  of 
England,  united  under  Mrs.  Butler's  leadership 
in  a  national  association,  issued  a  declaration  that 
the  law  was  an  insult  and  an  outrage  to  every 
woman  in  the  land,  and  protested  against  it  on  the 
following  grounds :  That  laws  are  bound  to  define 
offences  punishable  by  law.  (No  definition  of 
prostitution  was  given  in  the  Acts.  It  is  indeed 
most  difficult  to  define  it  technically  and  legally, 
and  this  difficulty  has  given  rise  to  active  con- 
troversy in  every  country  where  regulation  has 
been  in  force.)  That  it  was  unjust  to  punish 
women  only,  and  that  the  forced  medical  examina- 
tions were  degrading  punishments.  That  the 
Acts  made  it  easier  for  yoimg  men  to  be  impure. 
That  the  measures  of  enforcement  were  brutalising 
to  all  who  took  part  in  them.  That  venereal 
diseases  had  never  been  extirpated  by  such  means, 
because  their  causes  were  moral  and  must  be  met 
by  moral  prevention.  That  to  examine,  treat, 
and  isolate  women  only,  while  allowing  infected 
men  to  go  free,  was  a  farce. 

But  a  still  higher  groimd  was  taken.  Mrs. 
Butler  insisted,  in  her  speeches  and  writings, 
that  the  abolition  movement  was  not  merely 
a  sex  revolt,  but  was  based  on  the  conviction  that 


72  Hygiene  and  Morality 

impurity  was  as  perilous  for  men  as  for  women. 
It  was  as  citizens  first,  and  as  women  secondly, 
that  they  were  in  conflict  with  legislation  that 
practically  created  a  slave  class.  In  her  book. 
The  Constitution  Violated,  Mrs.  Butler  defined 
clearly  the 

Legal  and  Civic  Wrongs  of  Regulation. 

I.  The  first  principle  of  jurisprudence  in  en- 
lightened countries  is  that  a  suspected  or  accused 
person  is  protected  against  self-incrimination. 
The  "voluntary  submission"  is  a  self-incrimina- 
tion. 

II.  Enlightened  countries  hold  an  accused 
person  innocent  until  he  is  proven  guilty  and 
so  declared  by  a  jury,  but  under  the  Contagious 
Diseases  Acts  the  woman  was  held  guilty  until 
she  could  prove  her  innocence. 

III.  Constitutional  law  forbids  indecent  assault 
upon  the  person.  The  compulsory  medical  ex- 
amination constituted  an  indecent  assault. 

Mrs.  Butler  showed  further  that  the  spy  system 
necessitated  by  these  laws  subjected  women  to  the 
arbitrary  power  of  the  police  and  removed  them 
from  the  protection  of  the  common  law,  and  she 
made  plain  the  inevitable  confusion  of  the  pub- 


Control  of  Prostitution  73 

lie  conscience  arising  from  the  scruples  of  those 
persons  who  believe  that  the  only  wrong  thing  is 
disobedience  to  police  regulations. 

The  protest  embodying  these  civic  and  moral 
declarations  is  a  historic  human  document  which 
will  be  looked  back  upon  with  more  and  more 
veneration  as  the  centuries  pass.  It  was  the 
first  formal  declaration  of  the  revolt  of  women 
against  the  slavery  of  prostitution.  It  appeared 
in  the  Daily  News  on  New  Year's  day,  1870,  and 
was  signed  by  two  hundred  and  fifty  of  the  great 
moral  leaders  among  Englishwomen.  Beginning 
with  Harriet  Martjneau,  there  are  many  names 
known  to  literature,  social  reform,  and  advanced 
movements,  and  all  the  active  suffragists  of  that 
day  are  enrolled  there.  Half-way  down  the  col- 
umn appears  the  name  of  Florence  Nightingale. 

The  Struggle  against  the  Acts.  A  long, 
desperate,  and  unremitting  struggle  followed  the 
women's  protest.  Of  three  hundred  prominent 
men  in  all  walks  of  life,  secular  and  religious,  to 
whom,  as  an  initial  measure,  Mrs.  Butler  first 
wrote  letters  of  appeal  for  moral  support,  scarcely 
half  a  dozen  gave  a  word  of  encouragement. 
Some  declined  to  consider  the  subject,  but  most  of 


74  Hygiene  and  Morality 

them  were  silent.  Mrs.  Butler  then  turned 
for  help  to  the  public,  and  wrote  her  "Appeal  to 
the  People"  in  1870.  Tens  of  thousands  of  the 
working  classes  and  plain  people  came  to  her 
support.  Theirs  were  the  daughters  who  were 
chiefly  endangered. 

Perhaps  no  other  one  woman  has  been  more 
vilified  or  more  venomously  assailed  by  all  the 
corrupt  forces  of  society  than  was  she.  In  several 
instances  she  narrowly  escaped  death  from  mob 
violence. 

The  contest  was  carried  on  for  thirteen  years, 
and  the  abolition  party  grew  to  a  membership  of 
50,000,  but  during  all  this  time  political  parties, 
even  that  with  the  great  Mr.  Gladstone  at  its  head, 
resisted  all  appeals  and  ignored  or  belittled  all 
testimony  making  for  repeal  of  the  Acts. 

Progress  of  the  Crusade.  In  1871,  a  Royal 
Commission  recommended  abolishing  the  compul- 
sory examination,  and  raising  the  legal  age  of 
protection  for  girls  from  twelve  years  (as  it  then 
was)  to  fourteen.  The  first  recommendation 
was  not  enacted  into  law  until  1883.  The  second 
received  some  attention.  The  age  of  protection 
for  little  girls  was  with  difficulty  raised  to  thirteen, 


Control  of  Prostitution  75 

but  not  until  1885  was  it  possible  to  raise  it  to 
sixteen,  so  tenacious  and  determined  was  the 
resistance  made  to  this  amendment  by  the  law- 
makers of  the  nation.  As  late  as  1880,  two  mem- 
bers of  Parliament  spoke  on  the  floor  of  the  House 
in  favour  of  reducing  the  age  of  protection  for 
little  girls  to  below  twelve  years. 

In  1880,  '81,  and  'S2,  a  Select  Committee  was 
appointed  to  inquire  into  the  whole  question  of  the 
workings  of  the  Acts,  and  a  number  of  women 
were  called  to  testify.  Among  them  was  Mrs. 
Butler,  whose  evidence  was  very  full,  drawn  en- 
tirely from  personal  knowledge,  and  couched 
in  language  of  great,  often  exalted  beauty;  of 
moving  and  stirring  power. 

This  Committee,  in  its  report,  endorsed  the 
Acts,  but  did  not  recommend  their  extension,  and 
it  was  felt  that  this  was  a  victory.  In  188 1,  and 
*82,  there  was  also  a  Select  Committee  of  the  House 
of  Lords  on  the  white  slave  traffic,  and  in  1885 
the  Pall  Mall  Gazette  published  revelations  of  so 
shocking  a  nature  regarding  the  trade  that  Par- 
liament, until  then  most  reluctant  to  act,  was 
driven  to  pass  some  protective  legislation.  The 
odious  Acts  were  repealed.  They  still,  however, 
continue  in  force  as  to  some  of  their  main  features 


76  Hygiene  and  Morality 

in   distant   subjected   provinces   of    the    Empire 
under  the  guise  of  "rules." 

Rally  of  the  Regulationists.  During  the 
progress  of  the  women's  crusade  the  upholders  of 
regulation  in  all  countries  had  been  gathering 
re-enforcements  and  trying  to  strengthen  their 
position.  Government  officials,  military  author- 
ities, and  even  physicians  reasserted  the  right  of 
men  to  enslave  and  destroy  women  for  their 
sensual  pleasure.  The  Lancet  upheld  the  regis- 
tration of  prostitutes.  At  an  International  Med- 
ical Congress  in  Vienna  in  1873,  strong  resolutions 
were  passed  urging  a  convention  of  all  nations 
and  international  agreements  to  establish  the 
compulsory  system  of  supervision  of  women  in  all 
the  great  seaport  cities  of  the  world. 

On  that  occasion  one  member  present  said: 
*^  From  the  moment  when  prostitution  shall  become 
a  regular  and  recognised  institution,  admitted 
and  regulated  hy  the  state,  its  perfect  organisation 
will  become  possible.''  Another  made  an  even 
more  astounding  proposition  based  upon  the  in- 
oculation theory.  Resolutions  were  framed  call- 
ing upon  England  to  summon  a  congress  to  form 
an   international   league    for    the   regulation    of 


Control  of  Prostitution  77 

prostitution.  Rev.  C.  S.  Collingwood,  an  English 
clergyman,  protested  nobly  against  this  proposition, 
and  Mrs.  Butler  and  her  allies,  alarmed  by  the 
rising  tide  of  domination  of  the  regulationists,  deter- 
mined to  organise  an  international  movement  in 
opposition  to  them.  Mrs.  Butler  therefore  under- 
took a  continental  tour  in  1874,  the  year  of  the 
deepest  discouragement  and  when  everything 
looked  darkest  for  the  cause  she  had  at  heart.  As 
a  result  of  her  travels  and  speeches  the  foes  of  vice 
in  every  country  united  into  a  powerful  federation. 

The  Abolitionist  Congress  at  Geneva.  In 
1877  this  body,  the  International  Federation  for 
the  Abolition  of  State  Regulation  of  Vice,  as  it  is 
now  called,  met  at  Geneva,  five  hundred  strong 
and  representing  seventeen  coimtries,  and  passed 
a  notable  series  of  resolutions  under  the  sections 
into  which  the  congress  was  organised. 

Section  on  Hygiene.  It  was  resolved  (briefly 
stated)  that  self-control  in  the  relation  between 
the  sexes  is  one  of  the  indispensable  bases  of  the 
health  of  the  individual  and  the  community: — 
that  prostitution  is  a  fundamental  violation  of  the 
laws  of  health;  that  the  true  function  of  public 


78  Hygiene  and  Morality 

hygiene  is  not  only  to  supervise  disease,  but  to 
do  all  that  makes  for  public  health,  which  is,  in 
its  highest  expression,  inseparable  from  public 
morality: — that  all  systems  of  "Morals  Police" 
were  complete  failures  and  the  medical  examination 
revolting  to  human  nature  and  worthless  as  a 
sanitary  measure  by  reason  of  its  inevitable 
incompleteness;  that  it  was  impossible  for  the 
most  serious  forms  of  venereal  disease  to  be  so 
discovered  or  prevented  and  that  it  gave  a  false 
guarantee  of  the  health  of  the  women  subjected 
to  it. 

Section  on  Morality.  Resolved  that  license 
is  as  reprehensible  in  men  as  in  women : — that 
the  regulation  of  prostitution  destroys  the  idea 
of  the  unity  of  tL^  m  jral  law : — that  in  regulating 
vice  the  state  forgets  its  duty  to  afford  protection 
equally  to  both  sexes,  degrades  women  and  incites 
youth  to  evil : — that  the  system  of  licensed  houses 
raises  prostitution  to  the  rank  of  a  profession 
and  sanctions  the  immoral  doctrine  that  debauch 
is  a  necessity  for  men. 

Section  on  Social  Economy.  Exposed  the 
whole  condition  of  the  economic  dependency  of 


Control  of  Prostitution  79 

women,  and  traced  it  to  the  inequality  established 
by  law  between  men  and  women,  pointing  to  the 
unequal  wages  and  sex  slavery  of  women  as  proofs 
of  their  charges. 

Section  on  Legislation.  Resolved  that  the 
regulation  of  prostitution  lowered  women  to  the 
grade  of  chattels,  putting  them  beyond  the  pale  of 
the  law  and  inducing  the  state  to  violate  its  own 
penal  code  and  forget  its  duty  of  giving  protection 
to  the  yoimg. 

Decline  of  Medical  Support  of  Regulation. 
The  congress  of  1874  seemed  to  mark  the  highest 
point  of  medical  advocacy  of  regulation,  and  at  the 
medical  congresses  of  1876  and  1877  the  subject 
was  not  allowed  to  come  up,  as  it  became  known 
that  fearless  and  determined  antagonists  would 
appear.  At  a  Regulationist  congress  in  1894,  only 
three  supporters  of  the  "Morals  Police"  were 
present. 

It  would  be  interesting  and  useful  to  know 
just  how  much  of  the  change  in  the  medical  at- 
titude has  been  due  to  the  influence  of  women 
physicians.  From  the  time  of  the  entrance  of  the 
heroic  Elizabeth  Blackwell  and  her  sister  Emily 


8o  Hygiene  and  Morality 

into  this  hitherto  conservative  profession,  such 
women  have  consistently  and  steadily  presented 
the  nobler  and  more  ethical — more  spiritual — 
aspect  of  the  questions  relating  to  sex  physiology 
and  hygiene.  Elizabeth  Blackwell  early  declared, 
in  a  letter  to  her  sister,  her  determination  not  to 
be  intimidated  or  discouraged  in  the  difficult  task 
of  attacking  the  social  evil  by  methods  of  educa- 
tion, and  her  books  and  addresses  on  this  subject 
are  classics  in  their  dignity  and  nobility  of 
position.  She  was  the  first  to  address  herself 
to  parents.  In  1852  she  wrote  to  them  of  the 
Laws  of  Life  in  relation  to  girls,  and  in  1880  she 
wrote  to  them:  *'The  fact  must  be  clearly  per- 
ceived and  accepted  that  male  chastity  is  a  funda- 
mental virtue  in  a  State ;  that  it  secures  the  chastity 
of  women,  on  which  the  moral  qualities  of  fidelity, 
humanity,  and  trust  depend,  and  that  it  secures  the 
strength  and  truth  of  men,  on  which  the  intellectual 
vigour  and  wise  government  of  a  state  depend.'* 
From  that  time  on  women  physicians  as  an 
entire  body  have  stood  unitedly  for  a  single  stand- 
ard of  morals  and  for  the  education  of  the  public. 
In  their  ranks  there  can  be  found  no  division  or 
opposing  opinions  on  this  subject.  They  are  ac- 
tive in  the  warfare  against  vice,  in  every  country 


Control  of  Prostitution  8i 

where  medicine  has  opened  its  doors  to  women, 
and,  in  our  own  country,  they  have  been  publicly 
called  upon  by  their  colleagues  in  the  medical 
profession  to  carry  the  teachings  of  hygiene  to  the 
women  of  the  land.  Such 'women  as  Mary  Putnam 
Jacobi,  Sarah  Hackett  Stevenson,  and  Annie  Dan- 
iels have  brought  medical  science  into  perfect  har- 
mony with  the  most  advanced  civic  Standards,  and 
their  influence  will  be  lasting. 

The  First  and  Second  Conferences  for 
THE  Prophylaxis  of  Syphilis  and  the  Venereal 
Diseases.  In  1899,  the  first  international  con- 
ference of  important  medical  men  and  laymen 
met  imder  this  name  in  Brussels,  and  the  second 
conference  followed  in  the  same  city  in  1902.  An 
English  writer  says  of  the  proceedings  of  these 
two  weighty  bodies  that  they  marked  the  recon- 
ciliation of  justice  and  morals  with  science. 

The  first  conference  took  up  six  questions  for 
discussion;  they  were:  I.  Systems  of  regulation 
now  in  force; — have  they  an  influence  on  the 
frequency  and  the  dissemination  of  syphilis 
and  other  venereal  diseases?  II.  Medical  super- 
vision of  prostitution; — is  it  capable  of  improve- 
ment?    III.     Tolerated  houses; — is   there,  from 


82  Hygiene  and  Morality 

the  strictly  medical  point  of  view,  any  advantage 
in  maintaining  them,  or  is  it  better  to  suppress 
them?  IV.  Police  supervision; — how  to  improve 
it.  V.  Number  of  women  entering  upon  a  life  of 
prostitution; — how  to  decrease  it»  VI ,  What 
general  propaganda  could  be  made  against  pro- 
stitution ? 

Although  much  difference  of  opinion  as  to 
"regulation  and  control"  was  foimd  to  exist, 
as  the  discussions  went  on  the  following  con- 
clusions shaped  themselves  and  were  generally 
admitted. 

1.  The  intervention  of  public  powers  in  regu- 
lation as  it  exists  has  not  given  results  of  a  certain 
or  sufficient  efficacy. 

2.  The  prostitution  of  minor  girls  is  most 
dangerous  and  should  be  the  object  of  the  most 
radical  measures. 

3.  Better  university  instruction  in  venereology 

is  needed. 

4 .  The  public  power  should  be  used  to  teach  and 

to  disseminate  a  knowledge  of  prostitution. 

5.  There  should  be  a  uniform  system  of  sta- 
tistics of  prostitution  and  venereal  diseases  for  all 
countries. 

Disregarding   all  points  on  which   there   was 


Control  of  Prostitution  83 

an  absence  of  unanimity,  the  conference  passed  a  set 
of  eight  resolutions  which  were,  in  brief,  as  follows : 

Resolutions  of  the  First  Brussels  Con- 
ference. I.  All  governments  shall  be  called 
upon  to  suppress  absolutely  prostitution  among 
minors.  2.  Societies  of  Sanitary  and  Moral 
Prophylaxis  should  be  formed  in  every  country. 
3.  It  is  the  duty  of  governments  to  promote, 
by  complete  and  compulsory  tmiversity  courses, 
the  instruction  of  truly  competent  medical  special- 
ists in  venereal  diseases.  4.  Moral  teaching 
should  be  provided  for  orphans.  5.  The  utmost 
rigour  of  the  law  should  be  applied  to  men  who 
live  upon  the  profits  of  prostitution  (cadets, 
souteneurs,  etc.).  6.  Each  country  should  ap- 
point a  commission  to  study  conditions,  investigate 
the  number  of  hospital  beds,  dispensaries,  and 
other  opportunities  for  free  treatment  that  are 
available.  7.  Education  in  sex  morality  should 
be  offered  to  the  pubHc.  8.  There  should  be  a 
uniform  method  of  statistics  adopted  in  all 
countries  alike,  as  a  basis  of  correct  data  for  the 
combat  against  venereal  diseases. 

The    Second    Brussels    Conference.     The 


§4  Hygiene  and  Morality 

conference  of  1902  discussed  public  prophylaxis 
under  the  following  heads : 

A. — As  to  prostitution — what  legal  measures 
are  advisable?  I.  The  general  protection  of 
minors  of  both  sexes.  II.  The  improvement  of 
public  medical  relief,  hospital  dispensaries,  etc. 
III.  Contagion: — by  midwives;  in  obstetrics  gen- 
erally; in  shops  and  factories;  by  instruments;  as 
arising  in  the  management  of  employment  agencies 
and  intelligence  offices;  as  related  to  the  policing 
of  hotels  and  lodgings. 

B. — ^A  penal  code  for  the  transmission  of 
venereal  disease;  should  one  be  adopted? 

The  subject  of  private  prophylaxis  was  con- 
sidered under  the  two  following  heads :  I.  How 
to  teach  the  public  and  especially  the  young. 
II.     How  to  improve  the  public  medical  service. 

Statistics  and  special  communications  closed 
the  sessions.  This  second  conference  and  indeed 
both  were  very  remarkable  not  only  for  the  facts 
brought  out,  but  also  as  showing,  along  with  the 
rapidly  advancing  tendency  of  the  best  medical 
thought  to  think  in  unison  with  social  moralists 
on  this  question,  two  things  especially:  one,  the 
immense  handicap  of  involuntary,  unconscious  sex 
dominance  and  egotism  to  men  discussing  these 


Control  of  Prostitution  85 

problems:  the  other,  the  conspicuous  ignorance 
of  many  great  medical  specialists  in  matters  of 
sociology.  It  is  a  mistake  to  suppose  that  an 
eminent  authority  in  one  line  will  be  equally 
eminent  as  an  authority  in  another.  As  a  matter 
of  fact,  the  general  esteem  and  confidence  prof- 
fered to  the  medical  profession  by  the  public  has 
sometimes  encouraged  its  members  to  believe 
that  their  pronouncements  on  social  conditions 
are  as  final  as  their  definitions  of  medical  know- 
ledge. This  has  been  pointed  out  by  various 
critics  of  the  proceedings  of  the  two  conferences 
at  Brussels. 

Dr.  Pileur,  an  advocate  of  regulation,  ad- 
mitted that  the  diversity  of  opinion  on  this  point 
was  so  great  as  to  amount  to  anarchy.  He 
would  allow  adult  women  to  practise  prostitution 
with  the  agreement  of  three  [men]  commissioners, 
and  w^ould  hold  them  to  strict  rules,  pimishing 
them  for  infraction  thereof.  In  his  plan  no  men 
are  to  be  punished. 

That  was  his  theory:  his  facts  are  impressive. 
He  urges  the  reduction  of  prostitution  to  an  ir- 
reducible minimum,  and  believes  that  cutting  off 
the  minors  will  bring  this  about.  He  states  that 
seventy-five  per  cent,  of  all  prostitution  begins  be- 


86  Hygiene  and  Morality- 

fore  the  age  of  twenty-one ;  further,  that  of  these 
minor  girls  fifty  per  cent,  are  afflicted  with  vene- 
real disease  and  twenty-five  per  cent,  have  syphi- 
lis. These  figures,  he  holds,  are  understated  and 
would  be  higher  if  investigation  could  be  thorough 
and  precise.  He  judges  by  the  statistics  of  such 
girls  as  had  been  finally  arrested  in  Paris  as  "clan- 
destines,"  of  whom  seventy- two  per  cent,  were 
found  to  be  diseased  when  arrested.  He  holds 
that  the  prostitution  of  minors  is  the  absolutely 
capital  fact  in  the  question  of  prostitution  and 
insists  that  if  all  under  twenty-one  could  be  kept 
out,  the  number  of  women  choosing  the  life,  who 
might  be  called  ''chronic''  or  "persevering" 
prostitutes,  would  be  surprisingly  small.  From 
a  medical  standpoint,  he  considers  older  women 
as  less  liable  to  disease,  and  estimates  the 
amount  of  syphilis  among  them  as  seventeen  per 
cent. 

Dr.  Neisser  stated  that  the  unanimous  testi- 
mony of  all  nations  was  that  irregular  intercourse, 
especially  that  of  prostitution,  was  the  main  source 
of  all  ravages  by  venereal  diseases.  The  three 
factors  in  prostitution  that  are  fatal  in  the  hygienic 
sense  are:  Frequency  of  sex  relations;  absence 
of   choice   among   persons;   constant   variety   of 


Control  of  Prostitution  87 

persons.  Prostitution  is  the  knot  around  which 
contamination  centres.  Individual  immoral  re- 
lations are  less  dangerous,  and,  if  infection  then 
occurs,  it  has  been  accidentally  introduced  from 
prostitution.  Nevertheless,  he  advocated  the 
recognition  and  toleration  of  prostitution  as  a 
trade,  unavoidable  under  present  social  conditions, 
and  believes  that  it  strengthens  the  control  of 
the  police  over  thieves  and  criminals  to  have  the 
management  of  prostitution  within  their  juris- 
diction. After  expounding  this  last-mentioned 
curious  social  view,  he  advocated  teaching  the 
principle  of  chastity  to  young  men. 

Henri  Minod,  an  uncompromising  abolitionist, 
quoted  from  many  sources  to  show  that  real 
depravity  is  not  a  serious  cause  of  prostitution. 
Few  women  find  any  enjoyment  in  this  life.  They 
regard  it,  not  as  pleasure,  but  as  **work."  M. 
Minod  quoted  some  statistics  of  Dr.  Le  Pileur, 
to  show  the  ages  at  which  582  girls  were  drawn 
into  prostitution. 

Ages  at  which  Girls  were  Ruined: 

6  were  ruined  when  from  lo-ii  years  old. 
2     "         "  "         "     11-12       "       " 

8     "         "  *'         "     12-13      "      " 

24     **         '*  "         "     13-14      *•      ** 


88 


Hygiene  and  Morality 

50  were  ruined  when  from  14-15  years  old. 


142     **         ** 

*'     15-16 

106     *'         ** 

'*         "     16-17 

86     " 

"     17-18 

67     "         " 

**     18-19 

38     "         - 

"         **     19-20 

24     " 

"         **     20-21 

II     "         " 

"         **     21-22 

II     "         " 

'*         *'     22-23 

3     " 

"     23-24 

I  was       " 

"     24-25 

3  were      " 

"     25-26 

[A  set  of  figures  corroborative  of  these,  though 
not  presented  at  the  conference,  are  added  here 
as  being  germane  to  the  heading.  They  are 
given  by  the  Rev.  G.  P.  Merrick,  in  his  Work 
Among  the  Fallen. 

1 1  ruined  before  1 1  years  of  age. 


36   " 

*       12     * 

62    " 

'      13     ' 

104      *'           * 

'      14     * 

358      " 

*      15     ' 

1,192      " 

'      16     ' 

1,425      " 

'      17     ' 

1,369      " 

'      18     * 

1,158      " 

*       20     ' 

947      " 

'       21     * 

703      " 

'       22     * 

He  also  makes  statements  that  agree  with  those 


Control  of  Prostitution  89 

of  M.  Minod,  viz.,  that  out  of  100,000  cases 
personally  kno\^Ti  to  him  he  had  not  found  one 
hundred  who  did  not  loathe  the  life.  Drink,  said 
he,  was  a  necessity  to  nerve  them  to  endure  it.] 

Certain  ones  of  the  members  of  the  conference 
of  1902  advocated  laws  making  the  transmission 
of  venereal  disease  a  penal  offence.  The  weak 
points  of  this  proposal  were  forcibly  presented  by 
Miss  Blanche  Leppington,  of  England,  who  pointed 
out:  I.  Danger  of  unjust  accusation;  II.  Op- 
portunities for  blackmail;  III.  Dangers  of  pub- 
licity; IV.  Avoidance  of  such  retaliation  by  the 
self-respecting  and  its  exploitation  by  the  vile; 
V.  Resultant  estrangement  of  patients  from 
physicians;  VI.  Resultant  fostering  of  quackery. 
Careful  reading  of  the  full  proceedings  leaves 
the  settled  conviction  that  the  advocates  of 
toleration  and  regulation  have  a  weak  case,  con- 
tradict themselves  and  one  another,  and  grasp 
wildly  at  the  most  absurd  social  remedies;  while 
the  abolitionists  are  logical,  rational,  unanimous, 
and  show  some  knowledge  of  human  nature  and 
of  social  conditions.  Again  avoiding  all  con- 
troversial themes,  the  second  conference  agreed 
unanimously  on  the  following  resolutions:  That 
there  should  be  full,  adequate,  free  hospital  treat- 


90  Hygiene  and  Morality 

ment  for  all  cases  of  venereal  disease;  that  pa- 
tients should  not  be  regarded  as  guilty  persons, 
but  simply  as  patients;  that  teaching  in  sex 
hygiene  should  be  given  to  soldiers;  that  the 
education  of  the  public  should  be  continued  and 
that  emphasis  should  be  laid  on  the  doctrine  that 
the  health  of  young  men  is  improved  by  conti- 
nence ;  that  uniform  statistics  should  be  kept ;  that 
the  physiology  of  sex  should  be  taught  in  the 
schools  of  all  countries  to  the  children  of  all  ages. 
This  done,  the  conference  adjourned  without 
fixing  a  date  for  reassembling,  leaving  the  socie- 
ties that  had  been  formed  at  its  instigation  to 
carry  on  the  work  in  their  own  countries. 

The  Societies  of  Sanitary  and  Moral  Pro- 
phylaxis. Among  these  national  societies  newly 
formed  to  carry  on  educational  missions  in  regard 
to  venereal  diseases,  the  American  Society  of  San- 
itary and  Moral  Prophylaxis,  under  the  presidency 
of  its  founder,  Dr.  Prince  A.  Morrow  of  New  York 
City,  stands  easily  in  the  lead  by  reason  of  its 
singleness  of  purpose  (certain  others  still  wrest- 
ling with  the  vexed  question  of  regulation),  the 
unassailable  dignity  of  its  tone  in  promulgating  a 
teaching  which  harmonises  the  soundest  medical 


Control  of  Prostitution  91 

science  with  a  high  morality,  and  its  resultant 
widespread  influence.  Its  membership  is  open  to 
men  and  women,  to  the  professions  and  to  the 
laity,  and  this  association,  as  well  as  the  State 
Societies  to  which  it  has  given  the  impulse,  offers 
the  needed  opportunity  for  all  who  desire  to 
ally  themselves  with  the  new  crusade  for  the 
attainment  of  the  single  moral  standard  and  the 
extirpation  of  the  diseases  of  immorality. 

Regulation  Passing  from  the  Continent. 
The  reports  of  the  Brussels  Conference  show  that 
regulation  is  being  discredited  in  the  countries 
where  it  has  long  been  under  trial.  Norway 
abolished  the  Morals  Police  in  1888,  and  since 
then  the  Norwegian  women  have  defeated  pro- 
visions that  they  believed  portended  a  return  to 
regulation. 

Denmark  and  Sweden  both  reported  a  probable 
early  cessation  of  police  control  with  retention 
of  medical  inspection  only.  Italy  has  abolished 
regulation. 

France  has  had  two  government  commissions 
studying  the  subject;  one,  appointed  in  1901, 
had  no  results.  The  second,  appointed  in  1903, 
upon  which  one  woman  was  placed,  gave  a  verdict 


92  Hygiene  and  Morality 

of  banishment  for  regulation ;  decided  that  prosti- 
tution is  not  a  legal  offence  coming  under  the 
penal  law,  but  is  a  social  phenomenon  to  be 
combated,  but  not  with  force;  agreed  that  it  should 
be  made  punishable  to  "procure"  even  adults, 
even  with  their  own  consent,  and  framed  a  number 
of  resolutions  looking  to  a  rational  and  humane 
discouragement  of  prostitution  as  a  business, 
as  well  as  to  the  treatment  of  venereal  diseases. 
Their  conclusions  have  not  yet  been  enacted 
into  legislation,  but  the  force  of  public  opinion 
will  probably  soon  prevail  over  the  small  group 
of  determined  regulationists  who  still  resist  them. 

Danger  op  Regulation  not  Past.  In  spite 
of  all  the  available  testimony  against  it,  tolerated 
and  licensed  vice  still  finds  advocates.  Argu- 
ments in  its  favour  have  been  advanced,  and 
efforts  made  to  introduce  regulation  systems  in  this 
country.  Doubtless  such  efforts  will  be  repeated, 
from  time  to  time,  and  it  is  therefore  most  im- 
portant that  the  moral  public  should  be  well 
grounded  in  the  lessons  taught  by  English  and 
continental  experience,  and  ready  to  make  intel- 
ligent resivStance  to  any  such  attempted  invasion.* 

>  See  Appendix  A. 


Control  of  Prostitution  93 

There  have  always  been,  and  perhaps  always 
will  be,  some  honest  and  well-intentioned  apol- 
ogists for  regulation.  The  existing  writings  and 
speeches  made  by  members  of  this  class,  how- 
ever, such  as  may  be  found  in  the  transactions  of 
a  society  organised  in  England  during  the  cru- 
sade against  the  Contagious  Diseases  Acts, 
whose  aim  was  to  support  regulation,  show, 
alongside  of  perfectly  good  intentions,  an  extreme 
mediocrity  of  intelligence,  a  very  limited  point 
of  view,  and  a  profound  ignorance  of  their  sub- 
ject. Such  banal  opinions  as  that  erring  girls 
would  find,  in  the  police,  wise  and  benevolent 
friends,  who  would  lead  them  back  to  their  fami- 
lies; and  that  inscribed  women  would  become  so 
accustomed  to  the  routine  of  their  supervised  lives 
as  to  miss  it  if  discontinued,  show  sufficiently  the 
worth  of  their  information. 

On  the  other  hand,  all  accounts  teem  with 
evidence  of  the  disastrous  results  of  regulatory 
legislation,  and  this  evidence  will  now  be  summed 
up,  at  the  risk  of  a  certain  amount  of  repetition, 
in  order  to  bring  all  the  arguments  of  the  op- 
position into  one  place. 

Brutalising    Effect    of     Regulation    on 


94  Hygiene  and  Morality 

Character.  A  terrible  revelation  is  that  of  the 
brutalising  effect  of  regulatory  enactments  upon 
the  natures  of  those  who  administer  and  enforce 
them.  This  was  strikingly  shown  in  all  the 
evidence  laid  before  the  Select  Committee  in 
England,  and  appears  again  in  the  reports  of 
the  Brussels  conferences.  Officers  of  the  army 
and  military  surgeons  were  seen  to  have  reverted 
to  the  brute ;  as  in  the  case  of  the  one  who  ordered 
an  establishment  for  his  regiment  in  advance, 
and,  knowing  well  that  many  would  be  little  girls, 
excused  this  on  the  ground  that  "In  India  pro- 
stitution begins  in  the  cradle'*:  and  of  the  other, 
who  granted  permits  for  licensed  houses.  A  men- 
acing disregard  for  the  good  of  the  civil  community 
was  suggested  in  the  testimony  of  such  men,  that 
*' diseased  women,  if  incurable,  were  expelled  from 
the  cantonment."  But,  it  was  asked, — ^where  did 
they  go?  For,  unless  they  could  die  at  once,  they 
must  go  somewhere  and  be  a  danger  to  their 
environment. 

Equally  disturbing  evidence  of  the  decline  of 
traditional  chivalry  under  the  effects  of  the  super- 
vision of  vice  is  at  hand  in  the  suggestion  of  a 
German  surgeon,  who,  angered  by  the  failure  of  in- 
scribed women  to  appear  regularly  for  examination. 


Control  of  Prostitution  95 

would  have  had  them  whipped  for  absence;  and 
in  that  of  a  French  doctor  who  proposed  imprison- 
ing each  woman  for  several  days  before  examina- 
tion, in  order  to  prevent  their  tampering  with 
symptoms.  The  quarrels  and  disputes  between 
medical  and  police  supervisors  have  also  been 
numerous  and  undignified. 

In  reading  such  material,  one  feels  keenly  that 
the  supervision  of  vice  degrades  the  medical  pro- 
fession to  a  plane  little  higher  than  that  of  the 
cadet  or  souteneur. 

The  Insult  to  Religion.  The  insult  to 
religion  was  deadly.  There  was  (and  still  is) 
a  wide-spread  belief  in  distant  provinces  that 
licensed  prostitution  was  a  part  of  the  Christian 
religion.  The  editor  of  The  Sentinel  pointed  out 
the  incongruity  of  ordinances  passed  "in  the  year 
of  our  LOR.D"  for  licensing  vice,  and  Mrs.  Butler, 
in  her  evidence,  said,  "Few  things  shock  the  sense 
of  the  coimtry  more  than  the  fact  that  religious 
teaching  is  allied  with  state  regulation  of  vice." 
Even  as  late  as  1908  the  statement  appeared 
in  an  English  journal  that  one  reason  for  an 
outbreak  of  syphilis  in  an  African  province  was 
"the  introduction  of  Christianity." 


96  Hygiene  and  Morality 

The  Sanitary  Inefficiency  of  Regulation. 
The  entire  mass  of  testimony  makes  it  clear  that 
state  regulation,  licensing,  and  medical  examina- 
tion does  not  diminish  venereal  disease.  Con- 
flicting and  contradictory  columns  of  statistics 
do  not  alter  this  conclusion.  Dr.  Mounier  of 
Utrecht  says  that  statistical  methods  are  futile 
in  the  clearing  up  of  disputes  as  to  the  efflcacy  of 
regulation.  Figures  showing  results  favourable 
to  regulation  were  based  on  imperfect  knowledge. 
One  prominent  error,  made  before  the  discovery 
of  the  Spirochcete  pallida,  was  in  the  confusing 
of  venereal  ulcer  w4th  syphilis.  The  difference 
between  them  was  not  understood.  Remembering 
that  venereal  ulcer  is  the  least  serious  and  most 
readily  cured  of  the  venereal  diseases,  it  will  at 
once  be  clear  that  its  figures  might  easily  show 
an  improvement  which,  if  credited  to  the  graver 
disease,  would  be  most  misleading.  Again,  re- 
membering the  variable  period  of  inoculation  of 
the  SpirochcBte  pallida,  and  the  latency  of  the 
gonococcus,  possibilities  of  error  are  evidently 
many.  Still  another  source  of  error  lay  here: 
it  has  been  found  that  syphilis  shows  a  certain 
variability  when  observed  over  long  periods  of 
time,  having  its  epochs  of  increase  and  decrease. 


Control  of  Prostitution  97 

This  obscure  and,  to  many,  unknown  phenomenon 
makes  observations  over  short  time-periods  of 
little  value. 

The  reasons  for  the  sanitary  failure  of  regulation 
may  be  tabulated  as  follows: 

I.  The  One-Sided  Examination.  It  is  sur- 
prising that  the  plan  of  examining  women  only 
while  men  were  unexamined  should  ever  have 
been  advanced  as  worthy  of  being  taken  seriously. 
Morrow  says  of  this:  ''The  prostitute  is  but  the 
purveyor  of  the  infection; — she  simply  returns 
to  her  male  partner,  the  prostituant,  as  he  is 
called,  the  infection  which  she  has  received  from 
another  prostituant.  In  the  ultimate  analysis 
it  will  be  found  that  the  male  is  the  chief  male- 
factor." Again  he  says:  ''The  health  officer  of  a 
port  might  as  well  attempt  to  prevent  the  importa- 
tion of  infectious  disease  from  a  plague-infested 
vessel  by  quarantining  the  infected  women  while 
permitting  the  infected  men  to  go  free."  This 
weakness  has  been  admitted  in  official  circles,  and 
Neisser  and  others  at  the  conference  of  1902  ad- 
vocated examining  every  man  who  entered  a  house 
of  ill-fame.  The  naivete  of  this  suggestion  speaks 
for  itself.     Men  would   not  submit  to  it.     This 


gS  Hygiene  and  Morality- 

precaution  has  been  tried  occasionally  in  armies 
and  navies  and  has  been  rejected  as  a  "degrada- 
tion" involving  ''loss  of  respect"  to  the  men. 

II.  Length  of  Time  between  Examinations. 
The  usual  time  of  one  or  two  weeks  between 
examinations  is  too  long.  A  woman  may  appear 
free  from  disease  at  one  time  and  develop  an  in- 
fectious discharge  before  the  next.  This  has 
also  been  recognised  and  more  frequent  examina- 
tion recommended — even  one  or  two  weekly. 
But  aside  from  the  great  expense  to  the  tax- 
payers (many  of  whom  are  women)  in  supporting 
a  staff  large  enough  to  make  this  everywhere 
possible,  it  is  acknowledged  that  even  the  most 
enslaved  women  would  rebel. 

III.  Mediate  Contagion.  Mechanical  trans- 
mission of  disease  or  "mediate  contagion"  is 
believed  to  be  possible.  The  woman  in  this  case, 
remaining  uninfected  herself,  passes  on  to  one  man 
an  infection  which  she  has  received  from  another. 

IV.  Clandestine  Prostitution.  The  diffi- 
culty of  the  "clandestine"  is  perhaps  the  most 
obstinate  of  all.     So  great  is  the  detestation  of 


Control  of  Prostitution  99 

police  and  medical  control  among  women  that  the 
greatest  zeal  and  energy  on  the  part  of  the  officials 
cannot  prevent  numbers  of  them  from  practising 
secretly.  While  all  medical  authorities  agree 
that  these  are  the  most  dangerous  prostitutes, 
the  most  unfaltering  believers  in  regulation  can 
give  no  suggestion  for  strengthening  this  weak 
link  in  the  chain.  This  weakness  has  been  realised 
in  every  country  where  regulation  has  been  tried. 
Pontoppidan  wrote  in  1903  that  5000  women 
were  inscribed  by  the  police  of  Paris,  in  that  year, 
while  there  were  50,000  clandestines.  Figures 
for  Berlin  in  1896  were  even  worse;  viz.,  4039 
women  inscribed,  while  the  number  of  clandestines 
equalled  that  of  Paris.  Dr.  Kathe  Schirmacher 
has  recently  stated  that  the  police  of  Paris,  in 
the  last  thirty  years,  had  arrested  725,000  women 
and  had  inscribed  155,000.  Twenty-five  per  cent. 
of  those  inscribed,  she  added,  had  disappeared. 

V.  Regulation  Increases  Vice.  Ample  tes- 
timony is  at  hand  to  show  that  immoral  practices 
increase  with  the  sense  of  security  imparted  by 
official  inspection.  In  the  words  of  Dr.  C.  Bell 
Taylor,  there  is  ''multiplied  indulgence  springing 
from  the  apparent  immunity."     In  armies  it  has 


loo  Hygiene  and  Morality 

been  understood  that  the  government  purposed 
providing  the  regiments  with  "clean  girls,"  and 
in  civil  communities  young  men  speak  openly  of 
the  advantages  of  licensed  houses.  The  more 
wide-spread  immoral  practices  are,  the  greater 
of  course  must  be  the  danger  of  infection. 

VI.  Ignominy  Attaches  to  Treatment.  Un- 
der regulation  the  ignominy  attaching  to  the 
compulsory  treatment  deters  respectable  patients 
from  seeking  medical  aid;  brings  the  special 
hospital  into  disrepute  and  fosters  the  industry 
of  quacks,  who  offer  secrecy  and  regard  for  the 
sensitive  pride  of  the  individual.  The  seriousness 
of  this  danger  is  widely  recognised. 

Pont  oppidan,  after  a  moderate  and  rational 
review  of  the  whole  subject,  says:  "Control  is 
entirely  without  positive  value  as  a  security." 

Immoral  Nature  of  Regulation.  Aside  from 
sanitary  inefficiency,  regulation  stands  con- 
demned on  the  following  counts: 

I.  It  corrupts  and  demoralises  the  police 
and  offers  endless  opportunities  for  blackmail 
and  extortion.  Here  it  may  be  emphasised 
that,  although  there  is  in  the  United  States  no 


Control  of  Prostitution  loi 

legal  regulation  of  vice,  yet  there  is  blackmail  and 
extortion  because  the  police,  under  the  pressure 
of  corrupt  social  elements  have  developed  a  system 
of  protection  for  vice  which  approaches  closely  to 
an  official  alliance  with  it. 

2.  It  exposes  innocent  women  to  persecution. 
Numerous  instances  of  this  kind  are  on  record. 
Respectable  girls  have  been  reported  to  the  police 
from  motives  of  revenge  or  jealousy,  and  self- 
supporting  women  have  been  driven  from  positions 
and  their  property  manipulated  away  from  them. 
Cases  have  been  known  where  such  victims  have 
been  driven  to  suicide. 

3.  That  it  perpetuates  a  class  of  women  who 
are  deprived  of  the  protection  of  the  law  has  been 
referred  to.  For  such  women,  no  matter  what 
their  just  grievance,  justice  in  the  courts  would 
be  a  thing  unheard  of.  Even  without  regulation 
it  is  doubtful  whether  legal  justice  exists  for  these 
unfortunates. 

4.  Regulation  bears  with  special  hardship  on 
the  poorest  women.  Indeed,  it  may  be  said  that 
only  the  very  poor  and  defenceless  are  exposed 
to  its  full  horrors.  The  fact  that  immoral  women 
who  are  able  to  command  ample  means  are 
safe   against  the  severities  of  the  law  has  been 


I02  Hygiene  and  Morality 

frequently   mentioned    by   writers    belonging    to 
different  countries. 

5.  It  puts  governments  in  the  position  of  en- 
dorsing the  assumption  that  women  may  be  sacri- 
ficed for  men's  pleasure.  It  even  tends  to  make 
it  appear  that  women  are  the  chief  offenders 
and  the  primary  corrupting  influence,  and  may 
therefore  be  treated  with  a  disregard  of  justice 
and  decency.  On  this  point  M.  Jules  Favre 
said:  ''The  worst  that  could  befall  the  public 
health  is  nothing  to  the  corruption  of  morals  and 
national  life  engendered,  propagated,  and  pro- 
longed by  the  system  of  official  surveillance." 
Again,  with  regulation,  the  state  is  placed  in  a 
position  not  clearly  different  from  that  of  the 
individual  agents  of  immorality,  and  all  taxpayers, 
women  as  well  as  men,  are  compelled  to  pay 
for  the  maintenance  of  officials  to  supervise 
prostitution.  A  German  member  of  the  Reich- 
stag, speaking  on  this  point,  said:  ''The  state 
which  officially  tolerates  and  guarantees  houses 
of  prostitution  assumes  the  role  of  Procurer,  a 
delinquent  whom  the  German  penal  code  punishes 
with  imprisonment  and  hard  labour." 

6.  It  destroys  respect  for  women  and  thus 
tends  to  make  men  unmanly  and  cowardly.     And 


Control  of  Prostitution  103 

the  flourishing  and  unrestricted  commercial  pros- 
titution which  has  been  permitted  to  develop  in 
the  United  States  breeds  this  same  contempt  and 
unmanliness. 

7.  It  blights  that  high  ideal  of  parenthood 
and  especially  of  motherhood  that  consecrates  the 
functions  of  physical  life.  And  the  very  existence 
of  prostitution,  regulated  or  unregulated,  brings 
on  this  blight.  No  one  has  dwelt  upon  this  truth 
more  earnestly  than  Mrs.  Butler.  In  her  testi- 
mony before  the  Commons  Committee  she  said : 

There  is  nothing  in  the  physical  being  of  a  man  that 
corresponds  to  the  sacredness  of  the  maternal  functions 
in  a  woman,  and  these  functions,  and  every  organ 
connected  with  them,  ought  to  be  held  in  reverence 
by  man.  When  this  reverence  ceases  to  be  felt 
through  the  habitual  outrage  of  any  class  of  women, 
however  degraded  that  class  may  already  be,  the 
demoralisation  of  society  at  large  is  sure  to  follow. 

80  Finally,  it  is  clear  that  the  various  systems 
of  police  protection  and  state  licensing  of  prostitu- 
tion have  been  the  breeder  and  the  main  security 
of  the  most  shocking  of  modern  evils,  the  white 
slave  traffic. 

Systems  of  "segregation"  deserve  the  same  con- 
demnation as  regulation  and  for  the  same  reasons. 


CHAPTER  II 

THE  WHITE  SLAVE  TRAFFIC 

nPHAT  this  trade  in  girls  for  immoral  purposes 
■*-  has  grown  naturally  and  inevitably  out  of  the 
continental  system  of  regulated  vice  is  too  evident 
to  be  contested.  The  existence  of  this  traffic  was 
at  first  undreamed  of  by  Mrs.  Butler  and  her  asso- 
ciates, but  they  soon  came  into  collision  with  it.  In 
1879,  Mr.  Alfred  Dyer  received  information  that 
a  young  English  girl  was  detained  against  her  will 
in  a  licensed  house  in  Brussels,  and  intended  com- 
mitting suicide  as  the  only  escape.  By  the  aid  of 
a  Belgian  clergyman  she  was  rescued,  and  then 
began  a  life  and  death  struggle  for  the  exposure 
of  the  evil.  In  time  the  British  Society  succeeded 
in  obtaining  the  names  of  many  men  and  women 
who  were  systematically  engaged  in  this  trade 
in  London,  as  well  as  the  addresses  of  fifty  licensed 
houses    in    France,    Belgium,    and    Holland,    to 

which  the  girls  were  sold.     They  also  succeeded  in 

104 


The  White  Slave  Traffic  105 

exposing  all  the  methods  and  practices  in  the 
trade.  It  was  shown  that  the  exculpatory  state- 
ments of  the  police  were  false  in  every  particular ; 
that  girls  were  decoyed  under  pretence  of  obtaining 
employment,  and  that  there  were  systematic 
methods  of  intimidation.  It  was  proved  that 
girls  were  asked  in  foreign  tongues  whether  they 
came  willingly,  and  then,  not  understanding,  or 
thinking  they  were  entering  domestic  service,  they 
were  inscribed  as  having  come  of  their  own  free 
will.  Again,  they  were  listed  under  false  names 
and  then  threatened  with  imprisonment  for 
' '  forgery ' '  if  they  rebelled .  All  street  clothes  were 
taken  from  them.  A  skilful  system  involved 
them  deeply  in  debt  to  their  captors.  If  resistant, 
they  were  beaten  and  starved.  Padded  cells  were 
found  in  the  houses  which  were  visited  daily  by 
the  police,  even  the  windows  and  doors  being 
covered.  It  was  also  shown  that  the  names, 
persons,  and  pursuits  of  the  foreign  agents  in 
England  were  perfectly  well  known  to  the  police 
and  had  been  so  for  years,  but  "the  state  of  the 
English  law  did  not  authorise"  their  arrest  or 
extradition.  As  investigations  went  deeper  the 
traffic  in  England  was  traced  back  to  the  year 

1857- 


io6  Hygiene  and  Morality 

The  experience  gained  in  this  crusade  led  Mrs. 
Butler  to  say: 

As  an  inevitable  and  necessary  accompaniment 
of  the  establishment  of  licensed  houses  of  prostitu- 
tion under  government  patronage  all  over  the  world, 
there  exists  the  most  extensive  slave  traffic  in  the 
interests  of  vice.  This  fact  has  become  .  .  .  fully 
acknowledged  during  the  last  few  years. 

In  a  memorandum  to  the  Committee  of  the 
House  of  Lords  M.  de  Laveleye  wrote : 

The  white  slave  traffic  is  carried  on  .  .  .  and 
will  not  be  suppressed  as  long  as  prostitution  con- 
stitutes, on  the  continent,  a  traffic,  not  only  tolerated 
but  legalised,  privileged,  and  licensed  in  the  same  way 
as  any  other  traffic.  The  legal  organisation  of  de- 
bauchery is  the  chief  support  of  the  odious  trade 
against  which  we  are  seeking  a  remedy.  .  . 
This  state  of  things,  which  places  prostitution  on  the 
footing  of  a  recognised  commerce,  must  naturally 
produce  a  most  dire  effect  on  the  police  and  on  all  who 
are  brought  into  contact  with  these  abominable 
institutions.  .  .  .  The  traffic  in  women,  that  is 
to  say,  the  letting  on  hire  of  human  beings  for  de- 
bauchery, as  of  horses  and  other  cattle,  is  a  system 
contrary  to  all  morality  and  all  sense  of  right  and 
ought  to  be  universally  forbidden.  As  long  as  these 
establishments  remain  legalised  institutions,  the  traffic 
which  supplies  them  will  not  be  stopped. 

The   Share   of   Law   in   the   White   Slave 


The  White  Slave  Traffic  107 

Traffic.  The  members  of  the  British  Society- 
were  not  long  in  discovering  how  much  the  laws 
of  the  country  had  to  do  with  the  extent  and  the 
security  of  the  trade  in  girls.  Briefly  stated,  the 
features  of  the  laws  relating  to  the  protection  of 
girls  were,  at  that  time,  as  follows:  To  abduct 
a  girl  under  twenty-one  for  immoral  purposes 
was  a  felony,  if  she  belonged  to  a  propertied 
class  or  family.  If  she  was  propertyless,  it  was 
only  a  misdemeanour  to  abduct  her  under  sixteen. 
Thus  a  penniless  girl,  sixteen  years  old,  could  be 
lawfully  decoyed  for  immoral  purposes,  as  she 
could  claim  no  protection  from  the  state  or  its 
agents  the  police.  (And  here  again  let  it  be  recalled 
that  women  wage-earners  and  women  taxpayers 
were  helping  to  provide  the  public  funds  needed 
for  maintaining  such  legislation.)  But  still  worse 
was  the  discovery  that  girls  having  neither  parents 
nor  guardians  might  safely  be  abducted  even 
under  sixteen,  as  the  law  provided  no  penalty 
at  all  for  such  act,  nor  any  protection  for  such 
girls.  Here  w^as  obviously  a  deliberate  and  in- 
tentional legal  omission  devised  by  legislators  with 
the  sole  and  single  purpose  of  maintaining  a 
supply  of  victims, — not,  perhaps,  for  the  white 
slave  trade,  but  for  the  institution  of  prostitution. 


io8  Hygiene  and  Morality 

This  cannot  be  too  plainly  stated.  Such  careful 
legal  fencing  could  not  be  accidental;  and  that 
it  was  indeed  not  accidental  was  fully  proved, 
later,  by  the  long  and  stubborn  resistance  of  the 
lawmakers  to  any  amendment. 

Another  strange  feature  of  these  strangely  un- 
chivalrous  laws,  was  that  a  father,  having  reason 
to  believe,  but  not  possessing  legal  proof,  that 
his  daughter  was  in  a  house  of  prostitution,  could 
not  secure  a  search-warrant  to  look  for  her,  nor 
could  any  benevolent  friend  do  so. 

Facts  Learned  of  the  Trade  in  Girls.  The 
following  facts  were  brought  out  as  to  the  trade 
in  girls :  girls  between  sixteen  and  twenty  were  the 
most  desirable,  because  the  most  docile. 

It  was  important  to  entrap  only  healthy  girls, 
as,  if  any  were  found  to  be  diseased  and  to  require 
hospital  care,  the  trade  lost  money. 

A  skilled  system  of  falsehood  was  practised  in 
order  to  evade  the  fairly  strict  laws  of  continental 
countries  relating  to  minors. 

The  police  were  always  in  sympathy  and  some- 
times in  guilty  complicity  with  the  agents  and 
the  tolerated  houses.  One  European  police  offi- 
cial explained  their  attitude  thus:     ''We  cannot 


The  White  Slave  Traffic  109 

injure  establishments  legally  authorised  and  in 
which  so  much  capital  is  vested."  The  English 
committee  declared:  "Reliance  on  the  police  has 
misled  all  who  have  tnisted  to  it." 

Intelligence  offices,  all  licensed,  were  the  main 
avenues  of  the  trade.  The  girls  were  called 
"colis"  (packages)  and  the' business  was  perfectly 
organised,  with  routes,  ports,  agents,  and  travellers ; 
cargoes  and  technical  phraseology,  prices  and 
values  all  worked  out. 

English  birth  certificates  (false)  were  bought 
for  a  small  sum. 

Four  fifths  of  the  girls  so  enslaved  were  orphans. 

A  close  relation  was  fotmd  to  exist  between  the 
city  authorities  and  keepers  or  ow^ners  of  tolerated 
houses.  The  first  exposure  in  Brussels  implicated 
the  mayor  and  two  aldermen,  all  of  whom  resigned. 

The  Struggle  for  Improved  Legislation. 
The  history  of  the  attempts  made  to  amend  these 
laws  is  highly  instructive,  as  showing  the  different 
points  of  view  of  the  governed  and  the  governing, 
and  the  opposition  of  interests  between  enfran- 
chised men  and  unenfranchised  women. 

The  Society  sent  a  memorial  to  the  proper 
minister  in  1880  asking  for  a  deputation  to  be 


no  Hygiene  and  Morality 

received.  A  year  went  by  without  answer.  On 
making  a  second  appeal,  the  committee  were  in- 
formed that  official  inquiry  had  been  made  and 
it  had  been  found  that  the  Society  had  overstated 
the  case.  A  petition  signed  by  looo  women 
was  then  presented  by  Mrs.  Butler  in  1881.  An 
inquiry  by  the  House  of  Lords  followed.  Two 
years  later  the  Lords  reported,  making  various 
recommendations  for  the  better  protection  of 
girls.  The  House  of  Lords  passed  these  measures, 
and  the  House  of  Commons  defeated  them.  The 
same  thing  was  repeated  in  1884.  In  1885  a  third 
bill,  in  which  the  ''age  of  consent"  was  set  at 
fifteen  years,  was  about  to  be  killed  in  the  House 
of  Commons,  when  the  Pall  Mall  Gazette'^  brought 
out  its  revelations  which  aroused  the  public  wrath 
and  drove  the  legislators  to  act. 

The  White  Slave  Traffic  in  the  United 
States.  As  the  revelations  of  the  international 
traffic  in  young  girls  were  unfolded,  leaders  of 
communities  formed  National  Vigilance  Leagues 
to  carry  on  a  war  of  extermination  against  it. 
There  are  now  Leagues  in  Great  Britain,  Germany, 
France,  Russia,  Sweden,  Norway,  Belgium,  Hol- 

» July  10,  1885. 


The  White  Slave  Traffic  m 

land,  Italy,  Spain,  Portugal,  Switzerland,  Austria, 
and  the  United  States,  the  latter  having  been 
formed  in  1906  with  O.  Edward  Janney,  M.D.,  of 
Baltimore,  as  its  president.  These  Leagues  have 
brought  about  an  international  agreement  by 
which  the  governments  of  the  countries  repre- 
sented bind  themselves  to  a  concerted  action  in 
suppression  of  the  white  slave  trade.  In  1907, 
Congress  passed  an  act  designed  to  crush  the 
traffic  in  foreign  girls,  as  the  limitations  of  the 
constitution  of  the  United  States  confine  its 
jurisdiction  to  immigrants.  This  act  provided 
that  any  person  who  should  keep,  maintain, 
support,  or  harbour  any  alien  woman  for  immoral 
purposes  within  three  years  after  her  arrival  in  this 
coimtry  should  be  punishable  for  misdemeanour 
by  five  years'  imprisonment  or  $5000  fine.  The 
federal  government  has  no  power  over  traffic 
in  American  women,  carried  on  within  the  States 
themselves. 

In  the  process  of  enforcing  the  law  regarding 
aliens  the  United  States  District  Attorney  at 
Chicago  was  directed  to  take  the  proper  steps 
for  securing  the  conviction  of  certain  persons 
who  were  suspected  of  violating  the  statute.  The 
raids  upon  houses  of  prostitution  and  arrests  of 


112  Hygiene  and  Morality 

their  inmates  that  were  raade  with  this  end  in 
view  brought  to  hght  a  mass  of  evidence  of  a 
terrible,  much  of  an  unspeakable  nature,  and  the 
District  Attorney,  Edwin  W.  Sims,  and  his  assist- 
ant, H.  D.  Parkin,  as  well  as  convicting  a  number 
of  procurers,  felt  it  their  duty  to  make  known 
to  American  parents  the  conditions  imperilling 
their  daughters,  as  it  was  evident  that  a  profound 
state  of  ignorance  prevailed  as  to  the  existence 
in  our  country  of  so  vile  a  trade.  They  therefore 
wrote  a  series  of  articles  for  a  popular  magazine 
in  which  the  facts  they  had  learned  were  most 
clearly  and  explicitly  stated.  Their  investigations 
led  them  to  believe  that  some  65,000  American 
girls  and  15,000  aliens  are  being  entrapped  yearly 
for  the  white  slave  trade.  The  methods  by  which 
they  are  taken  vary:  promises  of  employment, 
bogus  messages,  plausible  invitations,  deceptive 
marriage  ceremonies,  even  real  marriage.  The 
runaway  marriage  is  a  device  frequently  used 
with  country  girls  of  American  families.  The 
District  Attorney  believed  that  there  was  a  syndi- 
cate which  carried  on  a  business  in  the  ruin  of 
girls  as  steady,  regular,  and  systematic  as  any 
great  business  of  a  legitimate  kind,  and  that  its 
ramifications  extended  to  the  Pacific  with  dis- 


The  White  Slave  Traffic         113 

tributing  centres  in  nearly  all  the  large  cities. 
Recent  Congressional  commissions  of  inquiry  be- 
lieve that  no  definite  syndicate  exists,  but  that 
there  is  a  general  understanding  between  the 
agents  in  different  cities.  This  is,  of  course, 
equally  menacing  and  serious,  and  does  not  relieve 
the  situation  of  its  darkness. 

Of  the  details  of  the  life,  Sims  repeats  almost 
the  very  words  of  the  English  investigators  into 
the  Brussels  conditions.     He  writes: 

When  a  white  slave  is  sold  and  landed  in  a  house 
or  dive  she  becomes  a  prisoner  ...  in  each  of  these 
places  is  a  room  having  but  one  door,  to  which  the 
keeper  holds  the  key.  Here  are  locked  all  the  street 
clothes,  shoes,  and  ordinary  apparel  .  .  .  the  finery 
provided  for  the  girls  is  of  a  nature  to  make  their  ap- 
pearance on  the  street  impossible.  Then,  in  addition 
to  this  handicap,  the  girl  is  placed  at  once  in  debt  to 
the  keeper  for  a  wardrobe  .  .  .  she  cannot  escape 
while  she  is  in  debt,  and  she  can  never  get  out  of  debt. 
.  .  .  Not  many  of  the  women  in  this  class  expect  to 
live  more  than  ten  years — perhaps  the  average  is  less. 
Many  die  painful  deaths  by  disease  [venereal]  many 
by  consumption,  but  it  is  hardly  beyond  the  truth 
to  say  that  suicide  is  their  general  expectation. 
.  .  .  The  facts  that  I  have  stated  are  for  the  awaken- 
ing of  parents  and  guardians  of  girls. 

Among  the  individual  instances  described  by 

8 


114  Hygiene  and  Morality 

the  District  Attorney  was  that  of  a  Httle  girl 
who  was  fourteen  years  old  when  stolen,  and  who, 
besides  being  used  as  a  scrubwoman  by  day,  in 
two  and  one  half  years'  time  had  been  compelled 
to  earn  eight  thousand  dollars  for  her  owner. 

The  statement  made  at  the  Brussels  conference, 
that  the  number  of  chronic  or  persevering  pro- 
stitutes, if  separated  from  the  others,  would  be 
surprisingly  small,  is  borne  out  by  Sims's  declar- 
ation that  only  about  twenty  per  cent,  of  all 
prostitutes  are  willingly  such,  or  have  chosen  or 
preferred  the  life,  while  all  the  other  eighty  per 
cent,  have  either  been  forced  into  it  by  poverty 
and  destitution,  or  have  been  betrayed,  trapped, 
enticed,  or  sold  into  it. 

The  National  Vigilance  League  has  published 
a  pamphlet  called  The  Nation  and  the  Traffic  in 
Women,  addressed  to  the  American  people,  in 
which  ample  facts  as  to  the  present  situation 
are  set  forth  with  moderation  and  as  entire  ab- 
sence of  sensationalism  as  the  extraordinary  truth 
permits. 

The  facts  speak  for  themselves,  and  the  ultimate 
responsibility  for  these  conditions,  in  an  unscru- 
pulous use  of  property,  and  in  the  protection 
secured  for  vice  by   corrupt  sordid   elements   of 


The  White  Slave  Traffic  115 

society  who  have  been  permitted  to  seize  the 
machinery  of  government  for  their  own  evil 
and  mercenary  purposes,  is  laid  squarely  where  it 
belongs,  at  the  doors  of  the  business  commtmity 
and  respectable  citizens  of  the  country. 

Mention  is  made  of  a  city  ''where  the  author- 
ities seem  to  regard  the  slavery  of  young  girls 
as  a  part  of  the  legitimate  business  of  the  city." 
Of  another,  where  the  money  to  build  slave  pens 
was  furnished  by  the  business  men  of  the  town. 
Procurers  of  young  girls,  it  is  pointed  out,  "are 
useful  to  the  politicians,  and,  when  arrested, 
escape  through  political  influence — ^while  smart 
lawyers  are  employed  to  defend  them  when 
arrested." 

The  hopes  of  dealing  an  effectual  blow  to  the 
white  slave  trade  were  painfully  frustrated  by 
the  decision  of  the  Supreme  Court  of  the  United 
States  early  in  1909,  which  set  free  the  traders, 
accused  by  the  federal  authorities,  on  the  ground 
of  the  unconstitutionality  of  that  clause  in  the 
immigration  law  under  which  they  were  pro- 
secuted. This  leaves  the  future  status  of  white 
slave  traders  to  the  slow  and  uncertain  action 
of  the  legislatures  of  the  States  of  the  Union, 
many  of  which,   it  has  been  found,   have  failed 


ii6  Hygiene  and  Morality 

entirely  to  provide  adequate  protection  for  young 
girls. 1 

The  Laws  of  Protection  for  Girls  in  the 
United  States.  How  high  the  standards  of  the 
States  are  likely  to  be  may  be  conjectured  from 
the  provisions  of  those  laws  designed  to  give 
protection  to  girls,  which  are  commonly  known 
as  the  laws  of  the  age  of  consent. 

This  age,  beyond  which  there  is  no  legal  pro- 
tection for  girls  against  seduction  and  violation  of 
the  person,  nor  punishment  for  men  committing 
such  acts,  was  originally  fixed  by  the  common 
law  at  ten  years. 

No  American  State  took  any  steps  toward  rais- 
ing this  age  until  1864.  From  that  time  to  the 
present,  the  insistent  urging  of  women  has  brought 
about  some  gradual  amendment,  though,  with 
the  fixing  of  a  higher  age  limit,  the  corresponding 
penalties  have  usually  been  reduced,  and  thirteen 
States  name  no  penalty  at  all  for  violation  of  the 
law.  The  following  data  are  taken  from  the 
History  of  Woman  Suffrage,  by  Susan  B.  Anthony 
and  Ida  Husted  Harper,  and  are  there  carried  up 

1  The  federal  law  of  19 10  which,  at  the  time  of  writing,  is 
before  Congress,  has  not  had  time  to  prove  its  effectiveness. 


The  White  Slave  Traffic  117 

to  the  year  1900.  It  has  been  thought  best  to 
retain  that  year  as  a  dividing  Hne,  and  leave 
changes  made  since  that  time  for  mention  in 
future  revisions. 

Three  States  then  had  the  age  of  ten  years  fixed 
as  the  age  of  protection  against  rape.  They  were 
Florida,  Georgia,  and  Mississippi.  Florida,  how- 
ever, recognised  two  grades  of  protection :  the  age 
of  consent  (ten) ,  and  the  age  of  protection  (sixteen 
at  first,  later  raised  to  eighteen).  Certain  details 
will  be  given  on  a  subsequent  page. 

Two  States,  Kentucky  and  West  Virginia,  gave 
protection  up  to  twelve  years.  One,  New  Hamp- 
shire, to  thirteen  years.  Ten,  Alabama,  Illinois, 
Indiana,  Maine,  Missouri,  Nevada,  New  Mexico, 
South  Carolina,  Virginia,  Wisconsin,  to  fourteen 
years.  Two,  Iowa  and  Texas,  to  fifteen  years. 
Nineteen,  Arkansas,  California,  Connecticut,  Da- 
kota, District  of  Columbia,  Louisiana,  Maryland, 
Massachusetts,  Michigan,  Minnesota,  Montana, 
New  Jersey,  Ohio,  Oregon,  Pennsylvania,  Rhode 
Island,  Tennessee,  Vermont,  Washington  to  six- 
teen years.  Nine,  Arizona,  Colorado,  Delaware, 
Idaho,  Kansas,  Nebraska,  New  York,  Utah, 
Wyoming,  to  eighteen  years. 

Some    brief   account   of    the   ways    in   which 


ii8  Hygiene  and  Morality 

amendments  to  these  laws  have  been  brought 
about  will  be  instructive  as  showing  that  it  is 
not  easy  to  improve  them. 

Arkansas  raised  the  protected  age  from  twelve 
to  sixteen  in  1893.  But  the  penalty,  which  had 
previously  been  not  less  than  five  years  nor  more 
than  twenty-five,  was  reduced  to  one  year. 

In  California  the  Women's  Christian  Temperance 
Union  asked  the  legislature  in  1887  to  raise  the 
protected  age  from  ten  (as  it  then  was)  to  eighteen. 
The  legislature  raised  it  to  fourteen.  In  1895 
the  women  secured  an  amendment  fixing  it  at 
eighteen.  The  governor  vetoed  it.  In  1897  the 
women  tried  again,  and  secured  a  bill  fixing  sixteen 
as  the  protected  age;  this  was  finally  passed  and 
became  law. 

Dakota  raised  the  age  from  ten  to  fourteen  in 
1887.  In  1895,  the  women  of  Dakota  tried  to 
obtain  legislation  fixing  the  age  at  eighteen,  but 
only  succeeded  in  getting  sixteen  years  enacted 
into  law.  Moreover  the  penalty  was  lowered  and 
the  following  clause  introduced : 

No  conviction  can  be  had  in  case  the  female  is 
over  ten  years  and  the  man  tinder  the  age  of  twenty 
and  if  it  appears  to  the  satisfaction  of  the  jury  that 
the  female  was  sufficiently  matured  and  informed  to 


The  White  Slave  Traffic  119 

understand  the  nature  of  the  act  and  to  consent 
thereto. 


In  Delaware  the  age  of  seven  years  only  was 
legally  protected  against  the  brutality  of  man 
until  1889.  In  that  year  the  women  of  the  State 
petitioned  the  legislature  and  secured  fifteen 
years,  but  the  penalties  were  lowered  and  no 
minimum  penalty  was  fixed.  In  1895  the  women 
brought  another  plea  and  obtained  eighteen  years. 
It  is,  however,  very  difficult  to  secure  convictions 
and  in  cases  where  men  have  been  convicted  they 
have  been  pardoned. 

In  Florida,  the  women  of  the  Christian  Temper- 
ance Union  made  many  attempts  to  have  the  age 
of  consent  and  of  protection  both  raised,  from,  re- 
spectively, ten  and  sixteen  years  to  eighteen. 
Their  bills  were  always  laid  on  the  table.  In 
1 90 1,  they  made  a  valiant  effort  with  two  bills: 
the  one,  raising  the  age  of  protection  against 
rape  from  ten  to  fourteen,  passed  the  House  but 
was  lost  in  the  Senate;  the  other,  raising  the  age 
of  protection  from  sixteen  to  eighteen,  was  finally 
forced  through  by  a  small  majority  and  in  the 
face  of  all  manner  of  obstructive  devices,  but  no 
minimum  penalty  was  attached  to  it.     The  age 


I20  Hygiene  and  Morality 

of  protection  against  rape  remained  at  ten  years, 
with  loopholes  for  the  evasion  of  the  penalty. 

In  Georgia,  the  suffrage  association  of  Atlanta 
tried  to  raise  the  protected  age  from  ten  to  eight- 
een. The  bill  was  killed  in  committee.  In  1899, 
the  attempt  was  again  made.  The  Women's 
Christian  Temperance  Union  also  came  forward, 
asking  for  twenty-one  years.  A  bill  raising 
the  age  to  twelve  was  brought  in  and  defeated. 
Reconsidered  at  the  plea  of  the  women,  it  was  re- 
defeated  more  emphatically. 

In  Indiana,  bills  urged  by  women  to  raise  the 
age  above  fourteen  have  never  been  permitted  to 
come  out  of  committee. 

Iowa  amended  her  law  in  1886,  raising  the  age 
from  ten  to  thirteen.  In  1896,  the  Women's 
Christian  Temperance  Union  secured  an  advance 
to  fifteen,  with  heavy  penalty,  but  a  clause  pro- 
vides that  the  man  cannot  be  convicted  on  the 
testimony  of  the  injured  person  without  corrob- 
orative testimony. 

In  Kansas,  immediately  after  women  obtained 
municipal  suffrage,  the  age  of  consent  was  raised 
from  ten  to  eighteen  years.  The  law  of  Colorado 
was  also  carried  by  the  women's  vote  in  their  first 
year  of  exercising  the  franchise.  - 


The  White  Slave  Traffic  121 

Michigan  raised  the  age  of  consent  from  ten  to 
fourteen  in  1887.  In  1895,  an  amendment  to 
eighteen  was  introduced  and  passed,  but  the  day 
after  the  friends  of  the  bill,  thinking  it  safe,  had 
gone  home,  it  was  reconsidered  and  changed  to 
sixteen. 

Minnesota  altered  the  age  from  ten  to  sixteen  in 
1 89 1.  Thousands  of  women  had  petitioned  in 
vain  for  eighteen. 

New  York  raised  its  protected  age  for  girls  in 
1887  from  ten  years  to  sixteen.  A  few  years  later 
there  was  an  attempt  made  to  reduce  it  to  twelve. 
The  women  made  themselves  heard  in  indignant 
protest  and  the  effort  was  relinquished.  In 
1895  the  age  of  eighteen  was  legally  secured.  It 
is,  however,  almost  impossible  to  secure  convictions 
and  many  flagrant  cases  of  assault  on  little  girls 
go  tmpimished,  the  writer's  long  experience  as  a 
district  nurse  having  brought  a  number  of  such 
cases  to  her  personal  knowledge,  where  the  mis- 
creants have  been  sheltered  behind  political  and 
police  -protection. 

It  is  natural  to  wonder  what  arguments  men 
can  find  for  defending  such  standards  on  the  floors 
of  legislatures:  this  has  been  answered  by  Dr. 
Elizabeth   Blackwell   from  English    history,  and 


122  Hygiene  and  Morality 

American  records  show  the  same  reasons  given. 
One  is,  the  need  of  protecting  men  against  black- 
mail for  false  charges,  and  the  other,  the  physical 
fact  of  the  early  oncoming  of  puberty  in  little  girls. 
That  it  is  possible  for  a  child  of  twelve  to  become 
pregnant  has  seemed  to  legislators  of  this  type 
reason  enough  for  regarding  her  as  a  matured 
woman. 


SOURCES  OF  MATERIAL  USED  IN  THE  PREPARA- 
TION OF  PART  II 

American  Society  of  Moral  and  Sanitary  Prophylaxis.    Trans- 
actions.    All  volumes. 
Amos,  Sheldon,  A  Comparative  Survey  of  Laws  in  Force  for 

the  Prohibition,  Regulation,    and  Licensing  of  Vice  In 

England  and  other  Countries.     London,  1877. 
Blaschko,  A.,  Syphilis  und  Prostitution  vom  Standpunkte  der 

offentlichen  Gesundheitspflege.     Berlin,  1893. 
Booth,  C,  The  Iniquity  of  State-Regulated  Vice.     London, 

1884. 
British  Committee  of  the  I.   F.  A.  S.  R.  V.     The  Shield. 

London. 
Brussels.     Conference  Internationale  pour  le  Prophylaxie  de 

la  Syphilis  et  des  Maladies  Veneriennes.     1899. 

,  The  same.     Second  Conference,  1902. 

Butler,  Josephine  E.,  A  Grave  Question.     London,  1885  or 

1886. 
Butler,   Josephine  E.,   Personal   Reminiscences  of  a  Great 

Crusade.     London,  1896. 
Butler,  Josephine  E.,  Principles  of  the  Abolitionists.     London, 

1885. 
Butler,   Josephine   E.,   The   Revival   and   Extension   of  the 

Abolitionist  Cause.     London,  1887. 
Committee  of  Fifteen,  The,   The  Social  Evil,  with  Special 

Reference  to  New  York.     New  York,  1902. 
Congres   des   Sciences   Medicales,    Compte   Rendu   R6sum6, 

Troisieme  Session,  Vienne,  1873.     Paris,  1876. 
Doll^ans,  E.,  La  Police  des  Moeurs.     Paris,  1903. 
Dyer,  A.  S.,  The  European  Slave  Trade.     London,  1880. 

123 


12  4  Hygiene  and  Morality 

Dyer,  A.  S.,  The  Slave  Trade  In  European  Girls  to  India. 
London,  1893. 

Fiaux,  F.  L.,  La  Police  des  Moeurs.     Paris,  1888. 

Geneva.  Conference  du  Geneve,  1899.  Federation  Abolition- 
iste  Internationale.     Compte  Rendu.     Geneva,  1900. 

Guyot,  Yves.  Prostitution  under  the  Regulation  System, 
1884. 

House  of  Commons,  Select  Committee  to  Inquire  into  the 
Contagious  Diseases  Acts.  Report,  3  vols.,  1880,  1881, 
1882. 

House  of  Commons,  Select  Committee  on  the  Contagious 
Diseases  Acts.  Minority  Report.  Reprinted  from 
Parliamentary  Papers,  340,  Session  of  1882. 

House  of  Lords  Committee,  Prostitution  in  Hong  Kong. 
(Parliamentary  Paper  C.  309.) 

House  of  Lords  Committee  on  the  Law  Relating  to  the  Pro- 
tection of  Young  Girls.     Report,  1881.     Appendix. 

House  of  Lords  Committee  on  the  Law  Relating  to  the  Pro- 
tection of  Young  Girls.     Reports  and  Papers.     Vol.  ix. 

Joest,  Wilhelm,  Du  Japon  en  Allemagne  par  le  Sib^ris. 
[Routes,  ports,  cargoes,  etc.,  of  white  slave  trade.] 

Ladies'  National  Association  for  the  Abolition  of  Government 
Regulation  of  Vice.     Publications,   London. 

Ladies'  National  Association  for  the  Repeal  of  the  Contagious 
Diseases  Acts,  Reports,  Liverpool,  1871.  Tracts  on  the 
Contagious  Diseases  Acts,  1871,  1883. 

London  Committee  for  Suppressing  the  TrafiSc  in  British 
Girls.     Reports  1881,  1885,  1886. 

McClure,  S.  S.,  The  Tammanyising  of  a  Civilisation.  In 
McClure's  Magazine,  November,  1909. 

Martineau,  Harriet,  Autobiography.  Edited  by  M.  W.  Chap- 
man, London,  1877. 

Martineau,  Harriet,  Letters  on  State  Regulation  of  Vice.  In 
Daily  News,  1859. 

Scheven,  Katharina,  Denkschrift  liber  die  in  Deutschland 
bestehenden  Verhaltnisse  in  Bezug  auf  das  Bordellwesen. 
In  Schriften  des  Bundes  Deutscher  Frauenvereine,  Heft. 
VL,  1904. 

Schirmacher,  Kathe,  M.D.,  The  Work  of  the  Extra- Parlia- 


Sources  of  Material  Used         125 

mentary  Commission  in  France.  Translated  from 
Der  Abolitionist.     In  "The  Shield,"  October,  1909. 

"Sentinel"  Tracts.     The  Licensing  of  Sin  in  India. 

Service  de  S4ret^  publique  et  de  Salubrite.  Rapport. 
Brussels,  1880. 

Stansfeld,  Right  Hon.  James,  M.P.,  The  Failure  of  the 
Contagious  Diseases  Acts  as  Proved,  etc.,  London. 

Stansfeld,  Right  Hon.  James,  M.P.,  Lord  Kimberley*s 
Defence  of  the  Government  Brothel  System,  etc.   1882. 

Stead,  W.  T.,  Josephine  E.  Butler:  A  Life  Sketch.  London, 
1888. 

Taylor,  C.  Bell,  M.D.,  The  Statistical  Result  of  the  Con- 
tagious Diseases  Acts  as  Deduced  from  the  Parliamentary 
Papers.     1872. 

Turner,  George  Kibbe.  The  Daughters  of  the  Poor.  In  Mc- 
Clure's  Magazine,  November,  1909. 

White  Slave  Traffic.     In  Pall  Mall  Gazette,  July,  1885. 


Part  III.      The  Prevention  of 
Venereal   Disease 


137 


CHAPTER  I 

UNDERLYING  PRINCIPLES  OF  PREVENTION 
rjROSTITUTIGN    TO    BE    PREVENTED.      The   genU- 

^  ine  prevention  of  venereal  disease  is  only 
made  possible  by  the  prevention  of  prostitution. 
Prostitution  cannot  be  retained  and  the  diseases 
fostered  in  it  be  eliminated.  Prostitution  must 
be  rooted  out,  unless  modem  civilised  states  are 
content  to  look  forward  to  the  same  fate  which 
befell  ancient  Rome. 

The  English  women,  as  they  worked  on  through 
their  crusade,  came  to  see  what  at  first  they  had 
not  realised,  that  what  they  were  making  war 
upon  was  actually  the  social  institution  of  prosti- 
tution itself.  Thirty-five  years  ago  Mrs.  Butler 
said,  in  a  public  address:  "That  we  are,  and  have 
been  all  along,  contending  for  more  than  the 
mere  repeal  of  these  unjust  and  unholy  Acts  of 
Parliament,  is  proved  by  certain  signs  which  are 

becoming  more  and  more  clear  and  frequent." 
9  129 


130  Hygiene  and  Morality 

She  went  on:  "We  were  perhaps  ourselves  un- 
conscious— some  of  us  are  probably  yet  uncon- 
scious— how  great  is  the  undertaking  upon  which 
we  have  entered,"  and  she  then  added  with  great 
solemnity,  "it  only  very  gradually  dawned  with 
perfect  clearness  on  my  mind  that  it  is  the  old,  the 
inveterate,  the  deeply-rooted  evil  of  prostitution 
itself  against  which  we  are  destined  to  make  war." 
Mrs.  Butler  was  saddened  by  seeing  that  some 
men,  who  had  aided  her  against  the  special 
tyranny  of  special  laws,  grew  cold  and  fell  away 
as  they  found  that  her  purpose  struck  at  the 
very  existence  of  prostitution  itself.  But  her 
ideals  of  lofty  personal  and  civic  morality  are 
now  justified  and  sustained  by  those  discoveries 
and  teachings  of  science  which,  in  her  day,  were 
still  unheard,  as  to  the  causation  and  propagation  of 
venereal  diseases  and  even  more  so  as  to  heredity. 
What  men  will  not  refrain  from  under  persuasion 
alone,  they  will  learn  to  refrain  from  under  the 
warnings  of  medical  and  sanitary  science,  when 
these  teachings  are  widely  disseminated  through- 
out all  social  circles.  Just  as  the  great  mass  of 
people  have  responded  with  readiness  and  in- 
telligence to  the  doctrine  of  the  pre  vent  ability 
of  tuberculosis,    so,  when   they  understand,  will 


Principles  of  Prevention 

^  131 

they  respond  to  the  doctrine  of  the  far  easie, 
preventabihty  of  venereal  diseases. 

Even  if  the  immoral  projects  of  some  writers 
could  be  realised  in  the  use  of  immunising  vaccines 
or  serums  to  enable  men  to  continue  indulgence 
with  greater  security,  venereal  diseases  would 
still  continue  to  exist  while  prostitution  exists,  and, 
unless  every  man  and  woman  in  the  world  could 
be  so  vaccinated,  there  would  be  no  security  that 
the  reckless,  the  unthinking,  and  the  unsuspecting 
innocent  would  not  continue  to  fall  victims  to, 
and  to  become  carriers  of,  these  deadly  scourges. 
Nor  is  it  credible  that  the  aroused  moral  sense  of 
humanity  would  consent  to  the  general  compulsory 
vaccination  of  syphilis  and  gonorrhoea  as  it  does 
to  that  of  smallpox,  because  moral  sense,  or  even 
plain  every-day  common- sense,  will  distinguish 
between  diseases  which  cannot  be  extirpated  by 
moral  living  and  the  exertion  of  self-control 
through  the  power  of  the  intelligent  will,  and 
diseases  which  can  be  so  extirpated.  The  deliber- 
ate use  of  immunising  substances  with  the  inten- 
tion of  making  it  hygienically  safe  for  men  to 
continue  a  brutal  misuse  of  women  such  as  falls 
far  below  the  practices  of  animals  in  vileness, 
could  only   be  tolerated  in   a  society  that   was 


^32  Hygiene  and  Morality 

Uady  for  its  own  ruin.  If  such  a  practice  is  to 
be  recommended  as  desirable  for  military  recruits, 
and  regarded  as  hopeful  by  military  authorities, 
then  this  is  only  one  more  reason  for  the  im- 
perative social  necessity  of  replacing  the  outworn 
military  ideals  by  those  of  a  higher  conception  of 
human  brotherhood.^ 

However  great  may  be  the  boon  science  has  to 
bring  to  the  present  victims  of  immorality  in  the 
form  of  merciful  antitoxins  which  may  shear 
disease  of  its  worst  terrors,  as  diphtheria  has  been 
shorn  by  the  serum  of  Behring,  it  will  nevertheless 
remain  true  that  real  prevention  does  not  rest 
there.  Dr.  Prince  A.  Morrow,  president  of  the 
American  Society  of  Sanitary  and  Moral  Prophy- 
laxis, says:  "It  is  not  a  question  of  making  prosti- 
tution safe,  but  of  preventing  the  making  of 
prostitutes."  This  lofty  teaching  is  now  being 
reiterated  by  ever  larger  numbers  of  the  foremost 
leaders  of  medical  science. 

There  are,  in  truth,  no  other  diseases  whose 
absolute  prevention  lies  so  wholly  in  human 
power  as  these. 

»  Various  articles  and  books  have  been  written  on  this 
line,  which  the  author  hesitates  to  mention  because  of  the 
possibility  of  seeming  to  recommend  them. 


Principles  of  Prevention  133 

Knowledge  is  Essential.  The  first  essential 
in  a  campaign  of  prevention  is  full,  open,  and 
serious  instruction  for  all  classes  of  society 
upon  the  situation  as  it  exists  to-day ;  instruction 
without  exaggeration,  but  also  without  conceal- 
ment, of  the  present  extent  of  disease  of  venereal 
origin,  and  with  the  most  emphatic  and  positive 
information  upon  the  real  source  of  danger  in 
prostitution.  It  will  be  found  that  not  only  is 
the  extent  to  which  venereal  diseases  have  been 
allowed  to  prey  upon  the  national  stock  utterly 
undreamed  of  by  great  numbers  of  highly  intelli- 
gent persons,  but  that  their  very  existence  is,  to 
thousands  of  others,  only  the  vaguest  hearsay, 
while  to  thousands  more  absolutely  unknown. 
Now,  as  in  combating  typhoid  fever  and  the 
plague  the  first  thing  needful  is  that  all  shall  know 
that  there  are  such  diseases,  whence  their  origin, 
and  how  they  may  be  cut  off  at  their  source,  so 
it  is  essential  that  every  citizen  shall  know  that 
there  are  venereal  diseases,  where  they  arise,  and 
how  they  may  be  exterminated. 

Therefore,  a  wide- spread  campaign  of  popular 
education  must  be  the  first  movement  made. 
This  has  already  been  begun  by  the  national 
societies  founded  for  the  purpose,  and,  as  their 


134  Hygiene  and  Morality 

task  is  a  most  difficult  one,  they  should  have 
the  active  support  of  every  right  thinking  man 
and  woman.  Extreme  difficulties  meet  this  move- 
ment at  the  outset,  arising  from  the  peculiarly 
personal  origin  of  these  diseases,  the  prevailing 
false  modesty  as  to  the  reproductive  functions,  and 
the  generally  dense  ignorance  of  the  physiology 
and  hygiene  of  the  generative  organs.  The  vulgar 
prudery  and  hypocrisy  of  a  past  age  compelled  all 
such  subjects  to  be  tabooed,  as  being  indelicate  or 
improper.  Perhaps  this  point  of  view  has  been 
encouraged  by  those  whose  interests  were  selfish 
or  evil;  certainly  nothing  could  bettei  serve 
such  interests  than  the  veil  of  silence  and  the 
cloak  of  embarrassment  drawn  over  subjects  so 
vital,  pertaining  to  functions  by  nature  so  sacred, 
but  by  man  so  horribly  debased.  The  function 
of  reproduction,  for  which  the  organs  of  generation 
have  been  evolved,  though  it  has  been  dragged 
through  the  mire  of  vulgar  thoughts  and  cruel 
abuse,  is  yet  the  noblest,  as  it  should  be  the  most 
held  in  reverence  of  all  human  powers.  Repro- 
duction is  natural,  and  should  no  more  be  re- 
garded vulgarly  than  are  the  changes  of  the 
seasons.  It  is  a  type  and  symbol  of  immortality. 
It  is  indeed  a  jDresent  and  visible  immortality, 


Principles  of  Prevention  135 

and  its  humble  physical  phenomena  should  never 
obscure  its  exalted  significance.  The  generative 
act  should  only  be  performed  in  the  sincerity  of 
aspiration  to  bring  a  new  being  into  the  world. 
Such  being  the  truth,  the  depravity  of  exercising 
so  miraculous  a  power  for  the  sole  desire  of  a 
passing  pleasure  of  sensation,  often  combining 
with  it  drunkenness,  and  orgies  in  which  all 
human  dignity  and  decency  are  cast  away,  is  so 
complete  that  the  decay  and  fall  of  nations  would 
seem  to  need  no  further  explanation. 

The  generative  organs  do  not  suffer  by  non-use. 
This  statement  is  now  being  emphasised  with 
great  earnestness  by  our  foremost  medical  teachers. 
Nor  does  the  general  health  suffer  by  their  non- 
use.  This  is  also  emphasised,  and  is  the  basis  of 
the  modem  scientific  teaching  upon  sex  hygiene 
that  is  now  being  given  to  young  men  in  the  uni- 
versities of  many  countries. 

It  must  be  seen  to  that  no  children  are  allowed 
to  grow  up  in  the  future  in  ignorance  or  with 
secret  vulgarised  notions  of  sex  physiology.  The 
simple  truth,  told  them  little  by  little  from  the 
earliest  age  at  which  they  begin  to  ask  questions 
and  in  a  way  which  will  appeal  to  their  idealism; 
then  later  teaching  in    the    schools   in  biology, 


136  Hygiene  and  Morality 

physiology,  and  nature  study,  will  go  far  toward 
prevention,  by  introducing  a  new  ideal.  The  teach- 
ing of  older  boys  and  girls  should  point  to  their 
responsibilities  to  future  generations. 

As  a  woman  physician  has  well  said,  young 
men  who  might  be  deaf  to  the  appeal  of  an  indi- 
vidualistic morality  may  be  moved  to  response 
by  the  presentation  of  their  debt  to  race  and 
country. 

The  education  of  fathers  and  mothers  must, 
in  the  future,  include  the  principles  of  heredity, 
the  toxic  effect  of  unholy  passions  upon  tempera- 
ment and  character,  and  the  study  of  eugenics,  the 
new  science  for  the  improvement  of  the  race  of 
man. 

First  and  last,  women  need  to  be  encouraged 
to  revolt  against  a  status  of  political  and  legal 
inferiority  which  is  the  direct  cause  of  their 
economic  and  social  degradation. 

Practical  Means  of  Prevention.  These 
may  be  divided  into  two  classes :  one,  the  means  of 
individual  care  or  personal  prevention  of  disease 
as  such;  the  other,  the  means  of  social  or  deep- 
lying  prevention  of  the  causes  of  disease.  The 
former  is  the  more  immediate,  the  latter  more 


Principles  of  Prevention  137 

fundamental.  The  former  will  soon  prove  to  be 
insufficient  without  the  intervention  of  the  latter. 
A  comparison  with  other  forms  of  infectious 
disease  may  serve  as  illustration. 

When  typhoid  fever  is  epidemic,  all  persons  are 
warned  to  boil  their  drinking  water;  yet' Boards 
of  Health  are  not  satisfied  with  that  individual 
precaution,  but  hold  it  necessary  to  protect 
remote  sources  of  water  supply,  no  matter  how 
great  the  initial  outlay  of  money. 

In  the  warfare  against  tuberculosis,  the  first 
thing  taught  is  the  proper  disposal  of  sputum, 
but  no  one  rests  satisfied  with  that,  and  presently 
it  becomes  evident  that  the  whole  question  of 
housing  and  of  occupation  presses  for  solution, 
bringing  with  it  the  details  of  rent,  of  land  monop- 
oly, and  of  private  ownership  of  the  means  of 
industry.  Or,  just  as,  in  the  expectation  of  raising 
a  certain  kind  of  crop,  the  farmer  begins  several 
years  in  advance  by  planting  something  quite 
different,  or  by  expending  capital  on  accessories, 
so  must  the  social  prevention  of  the  social  evil 
with  its  train  of  disease  be  arrived  at  by  remote 
and  indirect  routes. 

The  personal  precautions,  being  the  most  im- 
mediate, may  be  considered  first. 


138  Hygiene  and  Morality 

Personal  Prevention  of  Venereal  Disease: 
Childhood.  From  earliest  childhood  there  must 
be  prevention  of  all  habits  known  as  self-abuse 
or  masturbation,  namely,  all  stimulation  of  the 
delicate  nerve  centres  and  fibres  that  are  con- 
nected with  the  genital  organs.  Every  nurse 
knows  that  such  habits  may  arise  even  with  babies, 
in  complete  innocence,  of  course,  and  that,  if  not 
checked,  they  may  be  less  innocently  continued 
by  older  children  with  grave  danger  both  to  health 
and  morals.  Mothers  should  be  impressed  with 
the  dangers  of  this  habit  to  the  delicate  and  un- 
developed nervous  system  of  the  child.  Many  do 
not  know  how  real  these  dangers  are,  and  regard 
the  habit  as  an  unimportant  one,  believing  that  it 
will  be  outgrown,  as  sometimes  it  may  be.  Nurses 
should  teach  the  routine  of  absolute  cleanliness 
of  the  parts,  the  avoidance  of  overwarm  clothing, 
of  idle  luxurious  living,  of  rich  stimulating  food, 
and  above  all,  of  alcoholic  drinks  for  children, 
as  all  of  these  tend  to  excite  the  nervous  system, 
while  local  irritants,  such  as  uncleanliness  or  thick 
clumsy  clothing,  may  act  directly  upon  the  nerves 
of  the  skin.  Children  should  sleep  in  beds  alone, 
with  plenty  of  fresh  air,  and,  if  necessary  to  break 
up    a    tendency    to    self-handling,    their    hands 


Principles  of  Prevention  139 

should  be  so  confined  as  to  prevent  tendency 
from  becoming  habit.  Mothers  should  provide 
regular,  skilled  medical  inspection  for  all  children, 
that  no  abnormal  condition  may  be  overlooked. 
Sometimes  such  cases  require  surgical  interference. 
The  hygiene  of  the  older  child  calls  for  ample 
physical  and  manual  training,  daily  bathing  with 
cool  water,  friction,  and  rough  towels;  regularity 
of  all  excretory  functions;  fresh  air  and  not  too 
much  sedentary  or  solitary  or  monotonous  occu- 
pation. In  talking  with  mothers  upon  these 
subjects,  nurses  should  have  fortified  themselves 
by  careful  instructions  from  the  wisest  medical 
men  or  women.  Sensational  prophecy  of  the 
possible  results  of  masturbation  may  do  great 
harm,  yet  negligence  or  timidity  in  controlling 
it  may  do  even  more.  It  is  important  that  all 
mothers  should  understand  that  the  younger  the 
child  is  who  forms  the  habit  the  more  injurious 
is  the  practice  in  its  effects  upon  the  nervous  sys- 
tem. Furthermore,  it  is  the  conviction  of  Dr. 
Morrow  that  masturbation  tends  to  incline  its 
victims  toward  immoral  habits  and  leads  young 
men  to  debauchery. 

Dr.  Blackwell,  in  her  book.  The  Human  Element 
in    Sex,    deals    instructively    with    masturbation, 


I40  Hygiene  and  Morality 

specifying  its  chief  evils  as,  i,  the  injury  to  the 
mind  through  the  nervous  system,  and,  2,  the 
danger  of  habit-formation  with  resultant  loss  of 
self-control,  with  all  the  dangers  that  follow  upon 
this  loss  of  mastery  over  one's  self,  even  to  the 
destruction  of  health,  insanity,  or  suicide.  She 
says  in  another  place:  ''Precocious  physical  de- 
velopment hinders  moral  development/' 

Lowenfeld,  in  discussing  mental  working  power, 
says  that  it  is  oftener  injured  by  masturbation 
than  by  excesses,  adding: 

and  it  is  not  always  a  case  of  very  early  or  excessive 
masturbation;  in  many  cases  of  this  habit  there  are 
also  painful  reflections,  such  as  self-reproach,  self- 
accusation,  anxiety  for  consequences,  recollection  of 
religious  teachings,  which  affect  the  nervous  system 
and  through  it  the  mental  working  power. 

Older  Children.  For  older  children  there 
should  be  definite  warnings  of  the  dangers  which 
they  may  meet,  as  carefully  and  explicitly  given 
as  directions  in  taking  a  perilous  journey.  To 
leave  little  girls,  especially,  in  ignorance  of  what 
these  dangers  are,  is  as  wicked  as  it  would  be 
to  expose  them  to  wild  beasts.  Such  warnings 
should  be  given  at  an  early  age.  The  little  girl 
of  twelve  has  a  simple  seriousness  and  sagacity, 


Principles  of  Prevention  141 

which  may  be  looked  for  in  vain  if  she  remains 
untaught  and  undiscipHned  up  to  sixteen  or  sev- 
enteen, when  youthful  gaiety  often  runs  into 
recklessness. 

Such  warnings  need  not  cloud  the  happiness  of 
childhood  more  than  other  necessary  knowledge 
of  danger  which  is  likely  to  be  met,  and  even  if  it 
does,  better  that  than  the  tragic  fate  which  now 
overtakes  thousands  of  little  girls.  That  kind  of 
sentimentality  which  regards  the  ignorance  of 
children  in  the  face  of  the  worst  of  perils  as 
desirable  and  lovely,  is  a  sickly  and  unsafe,  it 
may  be  even  a  treacherous  sentimentality.  It 
would  at  least  seem  to  be  beyond  contradiction 
that  the  age  at  which  the  laws  cease  giving  pro- 
tection to  little  girls  should  be  the  age  at  which 
they  are  to  be  armed  with  the  knowledge  which 
will  help  them  to  protect  themselves. 

Youth.  Equally  criminal  is  it  to  let  the  boys 
go  to  boarding-school  or  college  without  the 
most  serious  and  intimate  counsel  and  w^arnings 
against  the  horrible  diseases  lurking  amidst  the 
"wild  oats"  that  they  may  thoughtlessly  sow. 

It  is  estimated  by  the  records  of  the  sickness 
insurance  system  of  Germany  that  25%  of  uni- 


142  Hygiene  and  Morality 

versity  students  become  infected  with  venereal 
diseases.  We  have  no  such  statistics  to  guide  us, 
but  the  writer  has  learned  from  the  personal 
knowledge  of  the  head  of  a  large  hospital  in  a  great 
university  centre,  of  the  numbers  of  young  men 
who  come  in  for  treatment  for  loathsome  diseases. 
A  painful  feature  of  this  calamity  is  that  "the 
mothers  are  never  told  the  truth ;  the  fathers  come 
and  some  reassuring  falsehood  is  sent  home."  It 
is  thus  evident  that,  in  such  cases,  the  mere  fact 
of  the  mother  knowing  the  truth  is  greatly  dreaded. 
Therefore,  if  it  could  be  certain  that  all  mothers 
would  learn  the  truth,  is  it  not  likely  that  a  power- 
ful deterrent  to  evil  courses  in  university  life 
might  be  brought  into  play?  If  this  is  the  result 
of  silence  and  ignorance,  the  questions  arise: 
''Is  this  really  shielding  the  sanctity  of  home 
life?  Are  not  these  mothers  guilty  of  a  serious 
shirking  of  duty  by  not  knowing,  if  their  knowing 
would  mean  even  partial  prevention?" 

Early  Adult  Life.  It  is  a  hopeful  sign  that 
the  ancient  heresy  of  ''physical  necessity"  for 
irregular  indulgence  by  men,  so  long  upheld  by 
them,  tacitly  assented  to  by  women,  and  even 
sometimes  taught  by  high  medical  authorities,  is 


Principles  of  Prevention  143 

now  being  gradually  repudiated  and  denied  by 
the  most  eminent  physicians  and  hygienists. 
To  maintain  it  has  been,  indeed,  an  insult  to 
all  those  men  whose  lives  are  and  have  been 
pure,  and  one  must  wonder  that  such  men  have 
so  long  permitted  so  detestable  a  doctrine  to 
go  unchallenged.  Young  men  may  now  be 
taught,  with  all  the  authority  of  science,  that 
the  same  virtue  which  is  desirable  for  their 
sisters  is  good  for  them,  and  that  ''physical 
necessity,"  like  drug  habits,  only  grows  coarser 
and  ranker  by  indulgence  and  weakening  of  the 
will  power.  Self-control  is  an  evidence  of  a 
strong  and  manly  nature  and  of  a  well-balanced 
physical  endowment. 

Marriage.  Medical  statistics  show  that  the 
vast  majority  of  all  innocently  contracted  cases 
of  venereal  disease  are  those  contracted  by  wives 
and  children  through  the  institution  of  marriage: 
that  fifty  per  cent,  of  the  sterility  of  wives  and 
from  twenty  to  twenty-five  per  cent,  of  the  steril- 
ity of  husbands  is  caused  by  the  gonococcus:  that  a 
large  per  cent,  of  miscarriages  and  a  heavy  infant 
mortality  are  due  to  the  SpirochcBte  pallida:  that 
fully  eighty  per  cent,  of  blindness  from  birth  and 


144  Hygiene  and  Morality 

twenty -five  per  cent,  of  all  blindness  is  gonorrhoea! : 
that  the  secondary  symptoms  of  inherited  syphilis 
often  cause  loss  of  sight  or  hearing:  that  from 
fifty  to  seventy-five  per  cent,  of  all  gyneco- 
logical operations,  often  involving  amputation  of 
the  female  organs  of  generation,  and  an  indefinite 
proportion  of  all  cases  of  chronic,  life-long  in- 
validism in  women  result  from  the  deadly  power 
of  persistence  of  the  gonococcus  and  its  tendency 
to  remain  latent  in  the  male  organs,  suddenly  to 
kindle  an  acute  inflammation  in  the  virgin  tissues 
to  which  it  may  gain  access:  it  is  therefore  plain 
that  the  most  extreme  precautions  of  personal  pre- 
vention need  to  be  taken  before  the  risk  of  mar- 
riage is  run.  No  parent  should  allow  a  daughter 
to  marry  without  securing  authentic  proof 
that  the  promised  husband  is  free  from  disease. 
This  is  incontestably  a  duty  of  parents  of  the 
utmost  gravity  and  importance,  neglecting  which 
all  their  previous  care,  expense,  and  nurture 
lavished  on  the  daughter  may  go  for  naught. 
An  honourable  and  virtuous  man  will  willingly 
give  such  testimony,  and  might  rightly  demand 
on  his  side  assurances  from  the  parents  as  to  their 
daughter's  inheritance.  Such  inquiries  are  not 
impossible.     They    could    all    be    conducted    by 


Principles  of  Prevention  145 

the  trusted  physicians  of  one  or  both  families 
with  entire  privacy  and  dignity.  Fathers  find 
ways  to  inform  themselves  of  the  business  standing 
of  prospective  sons-in-law,  and  health  is  far  more 
precious  than  money. 

What  personal  prevention  can  there  be  for  an 
innocent  partner  in  marriage,  if  in  later  years 
infection  is  brought  to  her  from  prostitution? 
It  would  seem  that  here,  as  in  the  case  of  the 
college  boy,  the  knowledge  that  the  truth  would 
surely  become  known  might  in  many  cases  act 
as  a  deterrent.  At  present  the  victim  (usually 
the  wife)  is  kept  in  ignorance  of  the  real  cause  of 
her  illness.  Certainly,  if  there  is  any  inalienable 
right  of  the  individual,  it  is  to  know  what  is  the 
matter  with  one  when  one  is  ill.  But  at  present 
two  barriers  are  interposed:  one  is  the  general 
ignorance  of  the  laity  in  matters  of  health  pre- 
servation; the  other  is  medical  reticence.  Only 
when  women  have  sufficient  general  knowledge 
of  health  and  disease,  and  courage  to  insist  on 
the  truth  and  to  accept  it  when  offered,  can  the 
second  barrier  be  broken  down.  Already  many 
physicians  are  chafing  against  the  shackles  of  the 
** medical  secret,"  and  they  are  sometimes  severely 
blamed  for  their  share  in  the  general  blindfolding 


146  Hygiene  and  Morality 

of  the  public  in  regard  to  venereal  diseases.  Yet 
to  speak  the  truth  in  individual  cases  exposes 
them  to  suits-at-law  and  other  most  trying  ex- 
periences. It  can,  however,  hardly  be  doubted 
that  the  certainty  of  truth  being  known  would 
in  time  have  a  salutary  preventive  effect  upon 
married  men.  It  would  at  least  be  a  simple  justice 
to  their  victims. 

« 
Prevention  of  Accidental  Infection.  Re- 
membering the  characteristics  of  the  SpirochcBte 
pallida,  its  extreme  virulence  while  living,  but 
short  life  period  outside  the  body;  and  those  of  the 
gonococcus,  with  its  equal  or  even  greater  virulence 
and  perhaps  somewhat  greater  tenacity  of  life 
outside  the  body;  remembering  that  neither  is 
conveyed  by  dust  or  through  the  air,  but  only  by 
material  objects,  it  should  be  possible  for  every 
one  to  guard  against  accidental  infection,  without 
suffering  from  exaggerated  alarm.  Common  drink- 
ing cups,  as  in  railway  cars  and  public  places, 
should  be  absolutely  avoided.  Individuals  should 
carry  their  own  cups.  Progressive  railroads  are 
now  providing  individual  drinking  cups  of  paper, 
to  be  used  once  and  then  thrown  away.  They 
should  be  demanded  of  every  public  service  cor- 


Principles  of  Prevention  147 

poration.  Towels,  too,  in  common  use,  must  al- 
ways be  regarded  as  possible  carriers.  They 
should  never  be  applied  to  the  face  and  eyes  unless 
freshly  laundered.  In  general,  it  should  be  a 
matter  of  universal  practice  never  to  rub  or 
even  touch  the  eyes  except  with  a  clean  piece  of 
linen — ^never  with  the  fingers  or  finger  nails,  as 
they  carry  all  manner  of  infectious  germs. 

The  face  should  not  be  washed  directly  from 
basins  that  are  used  indiscriminately,  especially 
for  rinsing  the  mouth.  Rubbing  the  face  with 
a  clean  wet  towel  may  be  substituted  in  travelling. 

Eating  utensils  which  have  been  washed  and 
dried  may  be  regarded  as  probably  safe,  yet  in 
many  places  it  would  no  doubt  be  an  added 
security  to  carry  one's  own  fork  and  spoon.  The 
fresh  cleanliness  of  bed  linen  cannot  be  too  care- 
fully looked  into  when  travelling.  The  conditions 
of  public  laundries  should  also  be  a  matter  of 
investigation  by  housekeepers.  The  seats  of 
public  water-closets  may  always  be  regarded  as 
being  more  or  less  doubtful,  and  when  used,  may 
be  covered  with  a  clean  piece  of  paper.  Many 
cases  of  gonorrhoea  are  caused  by  the  dirty  or 
ill-kept  seats  of  public  conveniences,  especially 
in  crowded  places.     Public   bath  tubs  should  be 


14^  Hygiene  and  Morality 

used  with  precautions  of  thorough  cleansing, 
and  if  doubtful,  had  better  be  let  alone.  No  ob- 
ject should  ever  be  put  to  the  lips  or  eyes  which 
may  have  been  so  handled  by  other  persons,  such 
as  pencils,  pens,  sticks,  etc.  To  put  money  into 
the  mouth  should  be  forbidden  by  the  Boards 
of  Health.  The  importance  of  having  individual 
towels,  face-cloths,  napkins,  utensils,  etc.,  is 
now  generally  recognised  in  institutions,  homes, 
asylums,  and  schools.  Such  articles  are,  if  used 
in  common,  of  course  capable  of  conveying  many 
kinds  of  infection,  and  it  will  be  seen  that  the 
avoidance  of  mechanical  contagion  of  venereal 
disease  is  much  like  that  of  tuberculosis  and 
pus  diseases,  the  chief  difference  being  that  of  the 
absence  of  danger  from  dust  in  the  one  and  its 
great  danger  in  the  others. 

In  caring  for  cases  of  venereal  diseases,  nurses 
and  others  should  observe  as  rigid  a  technic  of 
disinfection  as  in  diphtheria  or  other  acute  in- 
fectious fevers.  All  discharges  from  the  mucous 
membranes,  ulcerated  or  suppurating  tissues,  eyes, 
mouth,  or  nose  should  be  received  on  clean  waste 
material  and  promptly  burned.  Clothing  and  bed 
linen  should  be  boiled  or  sterilised,  then  well 
sunned    and    aired.     The    danger    of    infecting 


Principles  of  Prevention  149 

laundresses  by  unsterilised  elothing  should  always 
be  remembered.  Complete  isolation  of  dishes 
and  utensils  should  be  observed  and  they  should 
be  periodically  boiled.  Patients  with  mucous 
patches  should  never  expectorate  carelessly,  for, 
though  the  dried  germs  are  not  dangerous,  there 
is  always  the  possibility  of  direct  contact  in  some 
manner  before  the  death  of  the  germs.  Nor 
should  such  patients  sneeze  or  cough  w^ithout 
carefully  protecting  their  surroundings  by  covering 
the  nose  or  mouth.  This,  indeed,  should  be  the 
usual  routine  for  all  persons  at  all  times. 

It  is  the  right  of  every  nurse,  for  self -protection, 
to  know  what  she  is  taking  care  of,  and  it  should 
be  impressed  upon  all  nurses  that  they  must  in- 
variably insist  upon  knowing  the  diagnosis  in 
the  cases  they  care  for.  It  has  not  infrequently 
happened  that  nurses,  kept  by  the  attending 
physician  in  ignorance  of  the  venereal  origin 
of  patients'  maladies,  have  contracted  them.  It 
is  also  true  that  if  all  nurses  were  sufficiently 
well  taught  and  trained,  it  should  be  second  nature 
with  them  to  avoid  all  infectious  contact.  The 
proper  precautions  being  observed,  nurses  and  all 
others  should  comprehend  clearly  that  there  is 
no    danger  whatever  from  the    simple  presence 


150  Hygiene  and  Morality 

of  cases  of  venereal  disease  amidst  other  people, 
and  no  more  danger  in  caring  for  them  than 
there  is  with  cases  of  ordinary  sepsis.  Acciden- 
tal infection  arises  solely  from  ignorance;  this 
cannot  be  too  strongly  emphasised.  Proof  is 
amply  given  by  the  results  of  well-managed  ve- 
nereal wards,  where  infection  of  attendants  and 
nurses  does  not  occur.  French  experts  have 
recently  recommended  the  inclusion  of  adult  ve- 
nereal patients  (with  the  possible  exception  of 
extreme  cases)  in  the  general  wards  of  hospitals 
for  the  sake  of  the  better  moral  and  mental  in- 
fluence, and  explain  that  the  recommendation  is 
perfectly  practicable  because  with  the  proper 
technic  of  care  such  patients  need  not  be  regarded 
as  dangerous  from  the  stand-point  of  infection. 

In  conclusion  it  should  be  remembered  that  there 
are  probably  no  other  diseases  where  early  and 
competent  medical  advice  is  more  all-important. 
If  quackery  is  always  a  blunder,  here  it  is  a  fatal 
one,  and  nurses  should  use  their  whole  power  as 
teachers  to  impress  this  on  their  communities. 
All  the  social  circumstances  connected  with 
the  time  of  cure  and  return  of  such  patients 
to  normal  life  make  the  necessity  for  the  best 
medical  oversight  one  of  paramount  importance. 


Principles  of  Prevention  151 

Social  Prevention  of  Prostitution.  In 
order  to  approach  social  methods  of  preventing 
prostitution  in  a  perfectly  intelligent  way  there 
should  first  be  three  main  lines  of  inquiry,  which 
can  here  be  simply  indicated,  in  the  briefest 
fashion,  as  lines  on  which  there  is  work  waiting 
for  women  to  do.     They  are : 

First,  to  discover  the  extent  of  prostitution. 
Second,  to  ascertain  its  various  reasons  for  exist- 
ence,— ^what  they  are  and  how  much  diversity 
they  have  to  shov/.  Third,  to  penetrate  to  the 
social  arrangements  in  which  these  reasons  are 
imbedded,  and  to  see  how  much  there  is  here 
that  is  artificial  and  needless. 

The  right  attitude  of  mind  with  which  to  under- 
take such  inquiry  is,  that  it  is  rational  to  believe 
that  prostitution  and  its  resultant  diseases  can  be 
reduced  to  a  minimum,  and  that  it  is  possible 
for  that  minimum  to  be  discovered.  To  be  con- 
vinced that  it  can  be  and  inflexibly  determined 
that  it  must  be  discovered  is  no  more  visionary 
or  theoretical  than  it  has  been  in  the  past  to 
believe  in  all  the  dawning  possibilities  of  human 
progress.  There  was  a  time  when  it  was  thought 
that  the  plague,  typhus,  smallpox,  and  other 
infectious    diseases    could    not    be    conquered, 


152  Hygiene  and  Morality 

Science  has  indeed  not  banished  any  of  these  ills 
entirely  from  the  earth,  but  it  has  given  society 
the  knowledge  of  how  to  keep  them  down  to  their 
lowest  terms. 

The  Extent  of  Prostitution.  It  is  doubtful 
whether  correct  figures  could  be  obtained  at  present 
of  the  entire  extent  of  prostitution.  This  would 
be  the  first  task  to  undertake  in  initiating  an  ag- 
gressive campaign  against  the  institution  as  such. 
But,  taking  the  world  over,  being  guided  by  the 
statements  that  are  made  by  officials  and  social 
students  regarding  single  cities  and  coimtries,  it 
is  hardly  doubtful  that  there  are,  in  all,  several 
million  women  set  aside  in  this  life.  It  was  stated 
at  the  Brussels  congress,  conservatively,  that  there 
were  fifty  thousand  in  England.  Taber  Johnson 
estimates  the  number  in  the  United  States  at 
about  half  a  million  who  are  in  houses  of  ill-fame, 
and  believes  there  may  be  as  many  more  outside 
of  such  places.  In  exerting  the  imagination  to 
picture  this  number  of  women  pariahs  and  to 
call  them  together  in  one  mass  before  the  mental 
vision  in  order  to  personify  them,  and  to  consider 
the  problem  of  their  relation  to  disease,  it  is 
to  be  remembered  that  this  dreary  race  does  not 


Principles  of  Prevention  153 

perpetuate  itself.  Prostitutes  quickly  become 
sterile,  and  few  leave  children.  Their  lives, 
moreover,  are  very  short.  Some  authorities 
estimate  the  average  life  of  the  prostitute  as 
ten  years;  some  believe  it  to  be  even  less, — a 
five-year  average.  Between  these  two  estimates 
it  may  be  possible  there  is  a  mean,  but  even  this 
is  sufficiently  short,  especially  as  it  does  not  sig- 
nify their  working  life,  so  to  speak,  but  the  act- 
ual span  of  life.  In  from  five  to  ten  years  they 
die,  many  from  pneumonia,  tuberculosis,  alco- 
holism, and  suicide,  while  practically  all  of  them, 
says  Dr.  ^lorrow,  finally  become  cases  of  venereal 
disease  of  one  form  or  another.  Now,  if  it  were 
only  this  half-million  or  so  of  women  in  our  own 
country  who  were  doomed  to  early  disease  and 
premature  death  for  no  better  or  more  useful 
reason  than  to  gratify  the  brutal  and  selfish 
lusts  of  men  that  will  finally  destroy  those  very 
men  themselves,  this  alone  would  be  a  disgrace  to 
modem  hygiene  and  civilisation.  It  may  be  il- 
lustrated by  supposing  that  a  half-million  women 
were  set  apart  at  any  one  time  in  our  great  country 
to  be  infected  with  leprosy  or  to  be  compelled  to 
die  of  diphtheria.  AU  the  health  boards  of  the 
coimtry  would  be  in  a  state  of  desperate  activity, 


154  Hygiene  and  Morality 

and  the  daily  press  would  find  no  headlines  suf- 
ficiently sensational.  But  it  is  actually  even 
worse  than  this,  for,  in  order  to  fill  the  vacancies 
caused  by  disease  and  death,  some  50,000  fresh  and 
once  at  least  pure,  clean,  and  innocent  young 
girls  must  be  annually  drafted  into  this  death- 
dealing  business. 

Solely  as  a  matter  of  public  health,  without 
regarding  moral  considerations  for  a  moment, 
this  is  a  danger  of  paramount  importance,  yet  it 
meets  with  less  concern  from  health  boards  than 
half-a-dozen  smallpox  cases.  Indeed,  the  dis- 
covery of  one  smallpox  case  is  telegraphed  all 
over  the  country,  but  the  fact  that  numbers  of 
young  girls  are  set  aside  yearly  to  die  of  venereal 
disorders  and  their  tragic  accompaniments  is 
ignored  by  sanitary  departments  and  the"  press. 

From  this  point  of  view,  too,  the  extent  of 
prostitution  as  the  source  of  venereal  disease 
must  be  noted  in  the  light  of  the  computation 
of  experts,  that  for  every  abandoned  woman 
there  are  at  the  least  five  profligate  men.  Dr. 
Morrow  estimates,  from  carefully  collected  data, 
that,  of  the  young  men  in  this  country  reaching 
their  sixteenth  year  (numbering  770,000 annually), 
at  least  sixty  per  cent,  or  over  450,000  of  each 


Principles  of  Prevention  155 

year's  cohort,  will,  at  some  time  of  life,  become 
infected  with  venereal- disease,  and  that  twenty 
per  cent,  of  such  infection  will  occur  before  the 
end  of  the  twenty-first  year. 

Reasons  for  the  Existence  of  Prostitution. 

What  are  these  reasons  and  how  diverse  are  they  ? 
The  statements  of  the  United  States  District- 
Attorney,  as  wxll  as  of  speakers  at  the  Brussels 
conferences,  indicating  that  about  four  fifths  of  all 
prostitutes  are  unwillingly  such,  though  painful, 
have  a  hopeful  aspect,  as  they  point  definitely  to 
the  conclusion  that  prostitution  is  capable  of 
being  reduced  to  an  easily  controllable  minimum. 
If  these  four  fifths  of  unwilling  members  of  the 
sad  arm.y  could  be  withheld  from  entering  this 
life,  it  would  not  be  an  insoluble  problem  to  deal 
with  the  remaining  fifth.  Distributed,  as  they 
would  be,  over  the  whole  country,  the  number  of 
*' chronic  or  persevering"  prostitutes  with  which 
each  community  had  to  deal  would  not  be  an 
unmanageable  number.  If  they  were  irreclaim- 
able, they  could  be  kept  in  colonies,  tenderly 
and  wisely  cared  for,  as  are  the  insane  and  feeble- 
minded. If  this  ideal  method  should  be  too  ad- 
vanced, then,  when  there  were  really  only  the 


156  Hygiene  and  Morality 

prostitutes  by  preference  to  consider,  and  then 
only,  might  direct  legislation  of  a  punitive  char- 
acter for  women  be  spoken  of  without  bitter 
injustice  and  wrong. 

The  only  true  prevention  for  such  chronic  or 
determined  evil-doers,  and  the  prevention  that  the 
future  must  show  how  to  apply,  is,  not  to  have 
them  bom.  Who  can  say,  now,  that  they  are  not 
the  inevitable  hereditary  consequences  of  their 
parents'  sexual  excesses? 

Unwilling  victims  of  a  stupid  social  order  should 
not  be  regarded  as  true  prostitutes,  but  as  sacrifices, 
as  human  loss  and  waste  due  to  pure  mismanage- 
ment. The  underlying  reason  for  their  lapse  is 
poverty  or  the  unequal  struggle  against  want. 
All  medical  and  social  experts  who  have  studied 
this  problem  agree  that  prostitution  is  a  disease 
of  poverty.  Testimony  on  this  point  is  so  abun- 
dant that  it  is  not  necessary  to  prove  the  point 
here,  but  it  may  be  recalled  that  the  favourite 
buttress  for  the  arguments  of  those  who  uphold 
prostitution  and  licensed  vice  is  the  dictum  that 
"there  must  always  be  prostitution  because  there 
will  always  be  poverty." 

Poverty,  then,  must  be  so  far  eradicated  or  at 
least  so  far  mitigated  that  it  cannot  honestly  be 


Principles  of  Prevention  157 

given  as  an  explanation  of  prostitution.  This  is 
the  social  prevention  of  venereal  diseases  which 
are  fostered  in  prostitution. 

It  will  now^  be  clear  how  far-reaching  and  remote 
are  the  paths  along  which  the  prevention  of 
venereal  diseases  must  be  pursued.  They  lead 
even  farther  than  the  road  to  the  prevention  of 
typhoid  fever,  which  follows  the  water-courses 
back  to  the  pure  springs  of  the  head-waters.  And 
they  are  obstructed  by  the  same  obstacles  in  the 
mercenary  interests  that  have  become  parasitic; 
but  besides  all  these  they  are  blocked  by  one 
obstacle  which  no  other  contagious  disease  has 
ever  had  to  meet,  namely,  the  selfish  and  hitherto 
uncontrolled  pleasure  of  indulgence  of  the  individ- 
ual man.  The  prevalence  and  power  of  this  pleas- 
ure-lust make  it  hopeless  to  expect  that  a  majority 
of  men  will  give  it  up  themselves  of  their  own 
volition;  and  vain,  therefore,  is  it  to  look  to  their 
management  for  prevention  of  prostitution.  It 
will  be  found  again,  as  Mrs.  Butler  found,  that 
many  will  readily  lop  off  the  worst  manifestations 
of  this  institution,  such  as  the  white  slave  traffic, 
who  will  never  whole-heartedly  undertake  the 
eradication  of  the  institution  itself.  Already  this 
is  clear  in  the  articles  which  are  now  appearing 


158  Hygiene  and  Morality 

in  the  periodicals  and  daily  papers  upon  the  white 
slave  trade;  horror  of  the  trade  is  freely  expressed, 
with  shame  and  contrition  for  its  existence,  but 
one  may  search  vainly  through  the  lay  press  for 
any  bugle-call  to  men  to  put  an  end  to  prostitu- 
tion. This  must  be  the  work  of  women,  and  to 
do  it  they  must  possess  the  instrument  which  is  as 
indispensable  in  controlling  the  acts  of  legislatures, 
which  lie  behind  all  social  conditions,  as  is  the 
microscope  to  the  physician  in  his  research  work, 
or  the  scissors  to  the  mother  who  is  cutting  out 
her  children's  clothes. 

Enfranchisement  of  Women  the  First  Step. 
Long  ago  Dr.  Taylor  said  that  every  method  had 
been  tried  for  the  prevention  of  venereal  disease 
except  one,  and  that  was  the  teaching  of  conti- 
nence to  young  men.  But  Dr.  Taylor  was  wrong, 
though  a  good  and  noble  man;  for  in  his  day  no 
one  had  ever  dreamed  of  trying  the  remedy  of 
giving  power  and  authority  to  the  mothers  of  young 
men.  And  it  is  passing  strange  that  so  few  even  of 
the  men  sincerely  desirous  of  wiping  these  scourges 
of  disease  from  the  earth  should  think  of  this 
remedy,  even  when,  as  at  the  Brussels  conferences, 
they  have   racked  their   brains   for   suggestions 


Principles  of  Prevention  159 

and  have  put  forth  some  that  seem  almost  childish 
in  their  grasping  at  straws.  For  now  it  is  possible 
to  see  the  beginnings  of  what  women  will  do  with 
this  matter  of  prostitution  and  venereal  disease 
when  they  have  full  political  power.  To-day,  the 
only  parts  of  the  world  where  this  combined 
problem  is  progressing  toward  solution  are  those 
parts  where  women  have  been  in  possession  of  the 
ballot  long  enough  to  show  some  results  of  their 
direct  influence. ^ 

Only  the  determination  of  women  who  are 
politically  free,  expressed  through  the  machinery 
of  government  by  the  right  use  of  popular  govern- 
ment's only  instrument,  the  ballot,  can  effect  the 
downfall  of  prostitution  as  a  social  and  commercial 
institution.  Some  broad-minded  men  there  are 
who  do  see  this.  Professor  James  Stuart  said  to 
Miss  Emily  Ford,  of  England,  when  she  asked 
what  could  be  done  to  stop  commercialised  vice, 
''Go  on  trying  for  woman  suffrage'';  while  in  our 
own  country  there  are  medical  members  of  the 
American  Society  of  Sanitary  and  Moral  Pro- 
phylaxis who  take  the  same  position. 

Social  Steps  in  Prevention.     There  must  be 

»  See  Appendix  B. 


i6o  Hygiene  and  Morality 

full  and  ample  protection  for  children  from  the 
very  cradle, — yes,  even  earlier.  It  must  be 
possible  for  every  child  to  be  well  bom,  and  the 
pregnant  mother  must  be  protected  first  from 
want,  poverty,  and  sweated  labour. 

Child  labour  must  be  abolished  and  child-cul- 
ture substituted  for  it.  Children  that  are  forced 
into  the  labour  market  are  almost  foredoomed  to 
prostitution  and  venereal  disease  because  their  en- 
f  eeblement  and  premature  exhaustion  weakens  will 
power,  retards  useful  education,  and  warps  their 
natures,  whilst  the  exposure  to  all  sorts  of  moral 
dangers  cannot  be  avoided  by  little  wage-slaves. 
The  need  of  ample  legal  protection  for  little  girls 
has  been  sufficiently  shown  by  the  facts  of  the 
''age  of  consent"  laws.  These  laws  and  the  re- 
sistance of  legislatures  to  their  amendment, 
show  only  too  plainly  that  they  have  been  in- 
tentionally framed  and  kept,  not  for  the  protection 
of  girls,  but  for  the  protection  of  men  while  keeping 
an  open  door  through  which  a  sufficient  supply 
of  young  girls  may  be  continually  passed  into  ruin. 
This  is  a  painful  reflection,  but  it  is  the  only 
possible  conclusion  from  the  facts. 

But  further,  for  the  real  protection  of  girls  not 
only  legislation,  but  vigilant  administration  and 


Principles  of  Prevention  i6i 

unswerving  enforcement  of  law  must  be  had. 
Now,  the  former,  or  some  appearance  of  it,  may 
indeed  be  secured  as  a  concession  from  men,  but 
the  latter  can  never  be  hoped  for  until  women 
possess  the  same  public  and  legal  powers  that 
men  now  possess.^  This  is  a  point  that  is  almost 
invariably  overlooked.  The  flippant  query  so 
often  heard,  "Shall  we  have  women  police?" 
needs  to  be  answered  seriously  in  the  affirmative ; 
women  are  urgently,  desperately  needed  as  police 
wherever  yoimg  children  and  growing  creatures 
are  out  in  the  world,  and  the  time  may  not  be 
far  off  when  such  police,  with  the  training  of  the 
nurse  or  the  teacher,  shall  be  more  numerous 
than  those  we  are  now  familiar  with.  Then,  and 
for  the  first  time,  there  will  be  real  "morals  police." 
Widowed  mothers  must  not  be  compelled  to  act 
as  father  and  mother  both,  by  being  driven  to  earn 
their  children's  bread  outside  the  home  while 
trying  to  keep  their  little  ones  in  the  home. 
Through  this  double  burden  women  have  been 
driven  to  the  streets,  or  their  little  ones  have 
found  the  way  there.  There  are  seas  of  senti- 
mentality poured  forth  about  the  home, — but  it 
never  seems  to  be  the  home  of  the  working  people 
1  See  Appendix  C, 


i62  Hygiene  and  Morality 

that  is  meant.  Yet  these  are  the  majority  of  the 
homes.  To  one  of  America's  deepest-hearted 
and  most  clear-seeing  women,  a  sight  that  seemed 
too  intolerable  to  be  borne  was  the  sight  of  a 
working  mother  whose  abundant  milk  dripped  to 
the  floor  as  she  scrubbed  business  offices  for  sixteen 
hours  a  day.  Who  can  tell  how  such  sins  against 
family  life  will  end? 

The  real  protection  of  mothers  and  of  children 
will  be,  as  to  prostitution  and  venereal  disease, 
what  the  protection  of  the  head-waters  is  to 
typhoid  fever;  for,  as  Judge  Lindsay's  recent  true 
story  has  shown,  it  is  absolutely  essential  for  the 
children  to  he  ruined  at  a  tender  age,  if  a  vicious 
and  corrupt  class  is  to  he  maintained.^ 

The  fundamental  and  crying  need  in  the  protec- 
tion of  older  girls  is  a  living  wage.  It  is  only 
too  well  known  that  employers  in  every  country 
where  women  are  disfranchised  have  not  infre- 
quently given  to  their  young  employees,  along 
with  their  wage  pittances,  the  suggestion  that  it 
is  always  open  to  them  to  earn  more  without 
difficulty.  The  researches  recently  made  by  the 
National  Consumers'  League  into  the  relation 
between  the  cost  of  living  and  the  wages  paid 

>  See  Appendix  D. 


Principles  of  Prevention  163 

to  girls  in  industry  in  New  York  City,  striking  as 
they  have  been  in  their  demonstration  of  gross 
inequahty,  give  cause  for  added  thought  in  view  of 
the  official  information  that  that  city  is  the  centre 
of  the  white  slave  trade.  ^ 

Hours  of  work  need  to  be  shortened  for  all 
workers.  Overwork,  monotony,  and  chronic  fa- 
tigue make  all  work  hateful  and  destroy  healthful 
ideals,  while  the  long  hours  of  work  leave  no  time 
for  natural  enjoyment  or  pleasure  in  life. 

It  is  often  said,  as  a  piece  of  superior  wisdom, 
that  men  cannot  be  made  moral  by  law.  It  is 
only  superficially  true.  Conditions  which  make 
young  boys  and  girls,  yoting  women  and  men, 
or  older  women  and  men  immoral  by  necessity 
can  be  and  should  be  altered  by  the  law.  Indeed 
they  must  be,  because  the  whole  modem  social 
structure  rests  finally  on  the  support  given  to  it  by 
laws.  Intelligent  social  legislation,  when  rightly 
enforced,  is  like  the  fence  that  keeps  marauders 
out  of  an  orchard.  Vainly  does  the  gardener  put 
forth  his  best  work  if  the  fence  is  not  there  and 
the  despoilers  are.  If  we  could  get  rid  of  maraud- 
ers, we  might  do  without  fences,  as  the  French 
gardens  need  none. 

«  See  Appendix  E. 


164  Hygiene  and  Morality 

The  influence  of  unenfranchised  woman  is 
nulHfied  and  frustrated  precisely  as  are  the 
efforts  of  the  unprotected  gardener.  Her  fence 
will  be  the  ballot,  but  she  must  build  it  herself. 
The  marauders  who  threaten  her  are  all  the 
vicious  and  dangerous  elements  among  men  who 
know  that  her  supremacy  means  the  ultimate  dis- 
appearance of  that  social  evil  on  which  they  base 
all  their  profitable  exploitation  of  the  young  and 
the  helpless.  These  enemies,  though  the  most 
venomous,  are  the  most  silent;  they  are  never 
heard  in  arguments  against  woman  suffrage.  ^ 

English  women  writers,  medical  women  and 
the  leaders  of  the  suffrage  movement  both  m  Eng- 
land and  in  our  own  country,  declare  in  the  most 
explicit  terms  that  the  real  hostility  to  the  advance 
of  women  comes  from  those  who  exploit  prostitu- 
tion, while,  on  the  other  hand,  at  the  foundation  of 
the  terrible  earnestness  of  the  women  of  England 
to  gain  the  Parliamentary  franchise  is  the  burning 
and  unflinching  determination  to  free  womanhood 
from  this  disgrace.  In  this  country  the  story  is 
the  same,  though  not  so  well  understood  by  the 
great  mass  of  women. 

The  fear  of  the  "bad  woman's  vote"  has  long 

»  See  Appendix  F. 


Principles  of  Prevention  165 

been  dangled  as  a  spectre  before  the  eyes  of  timid 
good  women.  How  fictitious  this  fear  is  may- 
be realised  by  summing  up  the  testimony  proving 
that  eighty  per  cent,  of  the  *'bad  women"  need 
not  have  been  bad;  that  almost  all  prostitution  is 
commercial,  and  that  its  promoters  rely  chiefly 
for  their  supplies  on  the  ruin  of  children  of  tender 
years,  eking  out  with  young  girls  snared  in  their 
silly  and  thoughtless  age;  that  the  white  slave 
trade  is  now  and  always  has  been  supported  and 
protected  by  men  politically  corrupt ;  that  in  Col- 
orado, where  all  women  vote,  the  ** bad  women" 
actually  cast  just  one  third  of  one  per  cent,  of  the 
vote  of  Denver  1 ;  that  the  women  of  that  State, 
though  in  the  minority,  have  succeeded  in  placing 
model  statutes  for  the  protection  and  training 
of  children  upon  the  books,  and  have  helped  to 
maintain  in  power  against  bitter  enemies  the  one 
man  fearless  enough  to  enforce  and  reinforce 
them,  while  in  the  three  other  enfranchised 
states  not  a  word  is  ever  heard  about  a  ''bad" 
vote;  that  in  New  Zealand  prostitution  has  been 
reduced  to  its  lowest  terms,  while  commercialised 
vice  is  practically  extinct  there.     Well  did  Dr. 

1  Dr.  Aylesworth,  in  his  Carnegie  Hall  address,  Nov.  17, 
1909- 


1 66  Hygiene  and  Morality 

Aylesworth  say,  ''These  women  [the  prostitutes] 
exert  a  hundred  fold  more  influence  upon  poli- 
ticians through  their  business  than  through  their 
ballots." 

A  New  Ideal  Needed.  A  new  ideal  needs  to 
be  formed;  an  ideal  of  the  worth  and  dignity 
of  human  life,  and  of  a  commanding  place  and 
power  that  must  be  assumed  by  women  in  all  that 
pertains  to  the  cherishing  and  ennobling  of  the 
race.  This  ideal  must  be  built  upon  the  single 
standard  of  sex  morality  and  it  must  be  attained 
by  a  gradual  process  of  assumption  of  knowledge 
and  authority  by  women,  to  the  end  that  they  may 
finally  produce  a  nobler  and  a  finer  race  of  men. 


SOURCES  OF  MATERIAL  USED  IN  THE  PREPARA- 
TION  OF  PART'III. 

Abbott,  Edith,  Women  in  Industry.     1909. 
American    Society    of    Sanitary    and    Moral    Prophylaxis. 
Publications.     9  East  42d  St.,  New  York  City. 

The  Boy  Problem:     For  Parents  and  Teachers. 

The  Young  Man's  Problems:  For  Teachers. 

The   Relations   of   Social  Diseases   with   Marriage, 

and  their  Prophylaxis. 
How  My  Uncle,  the  Doctor,  Instructed  Me  in  Mat- 
ters of  Sex. 
Health  and  the  Hygiene  of  Sex:  for  College  Students. 
Anthony,   Susan   B.,   and   Harper,   Ida   Husted,  History   of 

Woman  Suffrage.     4  vols. 
Arendt,    Sister    Henriette    (for   five    years   assistant    police 
officer  in  Stuttgart,  in  charge  of  women  prisoners  before 
and   after    their    discharge),    Menschen    die   den   Pfad 
Verloren.     Stuttgart,  1907. 
Aves,  Ernest,  Report  to  the  Secretary  of  State  for  the  Home 
Department    on    the    Wages    Boards  and    Industrial 
Conciliation  and  Arbitration  Acts  of  Australia  and  New 
Zealand.     London,  1908.     (Blue  Book.) 
Blackwell,JElizabeth,  M.D.,  Counsel  to  Parents  on  the  Moral 

Education  of  Their  Children.     1880. 
Blackwell,  Elizabeth,  M.D.,  The  Human  Element  in    Sex, 

1884. 
Blackwell,  Elizabeth,  M.D.,  The  Laws  of  Life,  with  Special 

Reference  to  the  Physical  Education  of  Girls.     1852. 
Blackwell,  Elizabeth,  M.D.,  Medicine  and  Morality. 
Blackwell,  Elizabeth,  M.D.,  Pioneer  Work   in  Opening  the 
Medical  Profession  to  Women.     1896. 

167 


i68  Hygiene  and  Morality 

Blackwell,  'Elizabeth,  M.D.,  The  Religion  of  Health. 
Blackwell,  Elizabeth,  M.D.,  Wrong  and  Right  Methods  of 

Dealing  with  Social  Evil.     (No  date;  about  1860-70.) 
Broadhead,   State  Regulation  of  Labour  and  Labour  Dis- 
putes in  New  Zealand.     1908. 
Bureau  of  Labour,  Labour  Conditions  in  Australia  (Bulletin, 

Vol.  X.,  1905). 
Bureau  of  Labour,  Minimum  Wages  Act  of  1908  in  New 
South  Wales,  p.  86.     (Bulletin  No.  80.     January,  1909.) 
Conference  on  the  Care  of  Dependent  Children,  Washington, 

D.  C,  January  25,  26,  1909.     Proceedings. 
Eugenics  Education  Society.     Publications.     London. 
Immigration   Committee,    Report.     Importing    Women    for 

Immoral  Purposes.     (Senate  Document  No.  196.) 
Jacobi,   Mary  Putnam,    M.D.,   Common-Sense  Applied   to 

Woman  Suffrage.     New  York,  1894. 
Kelley,  Florence,  Some   Ethical  Gains  Through  Legislation. 

New  York,  1905. 
Lowenfeld,  Die  geistige  Arbeitskraft.     In  Grenzfragen  des 

Nerven  und  Seelenlebens.     Vol.  vi. 
Macrosty,    State   Arbitration   and   the  Minimum  Wage   in 
Australasia.     In  Trade  Unionism  and  Labour  Problems, 
edited  with  an  Introduction  by  John  R.  Commons,  p. 
195.     New  York,  1905. 
Martindale,  L.,  M.D.,  Under  the  Surface.  Brighton,  England. 
National  American  Woman  Suffrage  Association,     Political 
Equality  Leaflets: 

Blackwell,  Alice  Stone,  Fruits  of  Equal  Suffrage,  i., 

ii. 
Holder,  Lady,  Equal  Suffrage  in  Australia. 
Kelley,  Florence,  Woman  Suffrage:  Its  Relation  to 

Working  Women  and  Children. 
Macnaghten,  R.  E.,  Women's  Vote  in  Australia. 
Nathan,  Maud,  Wage  Earner  and  the  Ballot. 
Russell,  Charles  Edward,  Woman  Suffrage  in  New 

Zealand. 
Wells,  Mrs.  Borrman,  New  Zealand's  Experience.    • 
New  York  Probation  Association.     First  Report.     165  W, 
lOth  St.,  New  York  City. 


Sources  of  Material  Used  169 

Oregon  and  Illinois  Briefs  relating  to  Overwork.  The  Con- 
sumers' League,  105  E.  22d  St.,  New  York  City. 

Roosevelt's  (President)  Homes  Commission  Report.  (Sen- 
ate Document  No.  644.) 

Royal  Commission  on  the  Poor  Laws.  Minority  Report. 
London,  1909. 

University  of  London,  Eugenics  Laboratory  Lecture  Series. 
London. 


APPENDIX  A 

ATTEMPTS  TO  INTRODUCE  REGULATION  INTO  THE 
UNITED  STATES 

St.  Louis:  Attempt  made  in  1870  under  pretext  of 
suppressing  prostitution.  The  words  "or  regulate" 
introduced  into  a  clause  of  the  city  charter  established 
a  system  of  supervised  vice  which  continued  until 
1874,  when  it  was  abolished  by  the  force  of  public 
indignation. 

California:  In  18 71  the  legislature  had  a  bill 
brought  before  it  for  legalising  and  regulating  vice. 
The  wife  of  a  member  drew  up  and  had  presented  a 
bill  identical  with  the  first  except  that  the  word 
**man"  was  substituted  throughout  where  the  word 
** woman"  appeared  in  the  original  bill.  The  ob- 
noxious bill  was  withdrawn. 

Cincinnati:  In  1874  an  attempt  was  made  to 
regulate  vice  by  enactment  but  it  was  defeated. 

Pennsylvania:  In  1874  a  bill  was  presented  in  the 

legislature  for  the  State  regulation  of  vice.    Fifty-two 

171 


172  Hygiene  and  Morality 

medical  men  sent  a  noble  protest,  affirming  the  single 
moral  standard.     The  bill  was  defeated. 

District  of  Columbia:  Regulation  by  the  Board 
of  Health  was  proposed  in  1875  and  was  defeated. 

New  York  State:  About  the  same  date  similar 
legislation  brought  before  the  legislature  was  defeated 
by  the  power  of  Elizabeth  Cady  Stanton,  Susan  B. 
Anthony,  and  their  allies. 

[Data  taken  from  A  Comparative  Survey  of  Laws ^ 
etc.,  by  Sheldon  Amos.] 


APPENDIX  B 

EXAMPLES   OF  THE    KIND   OF   LEGISLATION   WOMEN   ARE 
ESPECIALLY  INTERESTED  IN  AND  WORK  FOR 

Wyoming:  Equal  pay  to  men  and  women  teachers 
of  equal  qualification. 

Age  of  protection  for  girls  raised  to  i8. 

Penalties  for  neglect,  abuse,  or  cruelty  shown  to 
children. 

Prohibition  of  the  labour  of  boys  under  14  in  mines. 

No  cigarettes,  liquor,  or  tobacco  to  be  sold  or  given 
to  persons  under  16. 

Free  public  kindergartens  established. 

Licensed  gambling  forbidden. 

Provision  for  the  care  and  custody  of  deserted  or 
orphan  children  and  children  of  infirm,  indigent,  or 
incompetent  persons. 

Colorado:  State  home  for  dependent  children 
established.  Two  of  the  five  members  of  the  board 
of  managers  must  be  women. 

Provision  that  at  least  three  out  of  six  members  of 
the  board  of  county  visitors  shall  be  women. 

173 


174  Hygiene  and  Morality 

Mothers  made  joint  guardians  of  their  children 
with  the  fathers  [this  equaHty  of  parents  exists  in 
only  thirteen  of  the  States  of  the  Union]. 

Age  of  protection  for  girls  raised  to  i8. 

State  industrial  home  for  girls  established;  three 
of  the  five  members  of  the  board  of  managers  to  be 
women. 

Protective  care  for  the  feeble-minded  provided. 

Woman  physician  placed  on  the  board  of  the  asy- 
lums for  the  insane. 

Juvenile  courts  and  truant  schools  established; 
education  compulsory  to  the  i6th  year. 

Union  high  schools  established. 

Advanced  regulations  for  child  labour  and  an  eight- 
hour  day  for  children  of  1 6  or  under. 

Prohibition  for  over  eight  hours  a  day  for  women 
working  in  occupations  that  require  standing. 

To  contribute  to  the  delinquency  of  a  child  made  a 
criminal  offence. 

Idaho:  Gambling  made  illegal. 
Age  of  protection  for  girls  raised  to  i8. 
Industrial  reform  school  established. 
Equalisation  of  married  women's  rights  in  property. 

Utah:  Equal  pay  for  men  and  women  teachers 
equally  qualified. 


Appendices  175. 

Age  of  protection  for  girls  raised  to  i8. 

Sale  or  gift  of  cigarettes,  tobacco,  opium,  or  any- 
other  narcotic  to  persons  under  i8  forbidden. 

Provisions  for  protection  of  children  against  neglect 
or  ill  treatment. 

Free  kindergartens  established. 

[The  above  examples  have  been  taken  from  pam- 
phlets by  Alice  Stone  Blackwell:  Fruits  of  Equal 
Suffrage,  I.  and  II.  Only  those  that  are  specially 
pertinent  to  the  subject  under  discussion  in  the  text 
have  been  chosen,  whilst  the  pamphlets  themselves 
give  numerous  other  examples  without  assuming 
to  show  a  complete  list.  It  is  pointed  out  that  laws 
of  this  character  are  much  better  enforced  where 
women  are  enfranchised.  The  leaflets  are  published 
by  the  National  American  Woman  Suffrage  Associa- 
tion, 505  Fifth  Avenue,  New  York  City.] 

New  Zealand:  Legal  standard  of  morality  and 
conditions  of  divorce  made  the  same  for  men  and 
women. 

Legal  separation  from  worthless  husbands  obtain- 
able summarily  and  without  expense. 

Testator's  Family  Maintenance  Act  prevents  a 
man  from  willing  away  his  property  without  making 
suitable  provision  for  wife  and  family. 


1 76  Hygiene  and  Morality 

Old-age  pensions  for  aged  persons  of  both  sexes ;  an 
old  couple  may  receive  a  joint  pension  in  their  own 
home. 

Government  asylums  for  inebriates  established. 

Health  of  women  workers  and  of  workers  of  both 
sexes  under  18  carefully  protected;  hours  of  labour 
and  legal  holidays  with  payment  regulated  [the 
eight-hour  day  is  legal] ;  payment  of  wages  to  learners 
in  trades  secured  and  workers'  compensation  for 
accidents  defined  with  great  advantage  to  the  working 
people. 

Purer  code  of  morals  established  by  alterations  in 
the  criminal  code. 

Adoption  of  children  regulated  by  law  and  baby 
farming  prevented. 

Industrial  schools  and  technical  schools  established. 

[From  Woman  Suffrage  in  New  Zealand^  pub- 
lished by  the  International  Woman  Suffrage  Alliance. 
Leaflet  No.  i.] 

Australia:  On  the  federal  domain  the  chief  gains 
so  far  are: 

Equal  pay  for  equal  work  in  government  depart- 
ments. 

Naturalisation  laws  made  equal  for  men  and  wo- 
men. 

Unified  marriage  and  divorce  bills. 


Appendices  177 

In  the  separate  (Australian)  states  the  gains  are: 
wages  boards;  children's  courts;  old-age  pensions; 
protection  for  wage -earning  children ;  married  women's 
property  acts ;  aid  for  the  illegitimate  mother ;  reforms 
in  the  drink  trade. 

[From  Where  Women  have  the  Vote,  published 
by  the  National  Union  of  Women's  Suffrage  Societies, 
25  Victoria  St.,  Westminster,  London;  quoting  Miss 
Alice  Zimmern's  Women's  Suffrage  in  Many  Lands. 1 

12 


APPENDIX  C 

SOME   STATISTICS   OP  CRIMINAL  ASSAULT  UPON  YOUNG 

GIRLS  ^ 

By  Mary  Burr,  Delegate  to  the  International  Congress 

of  Nurses  of  the  National  Council  of  Trained 

Nurses  of  Great  Britain  and  Ireland. 

Statistics  are  usually  considered  very  dry,  but 
when  those  figures  mean  ruined  lives,  as  they  do  in 
this  paper,  then  they  assume  an  aspect  which  should 
command  our  very  closest  attention.  In  endeavour- 
ing to  gather  these  statistics,  it  was  originally  intended 
to  draw  as  far  as  possible  upon  private  sources. 
These,  however,  proved  inadequate,  and  a  dozen 
different  societies  which  deal  with  wronged  women 
and  children  were  approached  for  whatever  informa- 
tion they  could  give. 

The  results  proved  somewhat  curious;  from  only 

iRead  at  the  International  Congress  of  Nurses,  London, 
July,  1909.  Reprinted  in  the  British  Journal  of  Nursing, 
Nov.  6,  1909. 

178 


Appendices  1 79 

two  did  I  receive  any  definite  information — the 
National  Society  for  the  Prevention  of  Cruelty  to 
Children  and  the  Church  Penitentiary  Association. 

Of  the  other  societies,  six  referred  me  to  some  one 
else,  and  even  the  National  Vigilance  Society,  from 
which  I  expected  much,  referred  me  to  the  Director 
of  Public  Prosecutions;  the  remainder  said  they  did 
not  deal  with  such  cases. 

One  lady  flatly  refused  to  furnish  information 
which  she  considered  private  to  a  congress  of  which 
she  knew  nothing. 

It  made  one  wonder  if  this  work,  which  so  closely 
affects  the  national  well-being,  is  a  private  preserve, 
reserved  to  those  who  work  in  it.  It  almost  appears 
so.     Information  was  sought  on  four  points  only: 

1.  The  number  of  cases  of  criminal  assault  com- 
mitted upon  young  girls  and  children. 

2.  The  number  of  cases  in  which  prosecution 
followed. 

3.  The  result  of  the  prosecution. 

4.  The  ages  of  the  victims. 

The  idea  was  to  find  out  as  far  as  possible  the 
extent  of  this  awful  evil;  what  proportion  of  the 
offenders  were  punished  and  the  degree  of  punish- 
ment inflicted,  because,  of  various  cases  which  had 
come  to  my  knowledge,  only  a  very  small  proportion 
were  brought  to  justice.     As  so  little  information 


i8o  Hygiene  and  Morality 

was  obtained  from  the  societies  from  which  I  had 
hoped  to  gain  so  much,  I  took  the  advice  of  one  secre- 
tary, and  bought  the  Blue  Book  of  Criminal  Statistics, 
and  here  is  the  result. 

Comparative  statistics  are  given  for  15  years 
from  1893  to  1907;  the  details  of  1907  only  are  given. 
In  those  15  years  there  were  2302  cases  of  defilement 
of  girls  under  13  years  of  age,  and  2442  cases  of 
defilement  of  girls  under  16  years  of  age,  making  the 
terrible  total  of  4744  cases  reported  to  the  police. 

Of  these  3425  were  tried — 1660  for  assault  on 
girls  under  13,  the  remaining  1765  being  for  girls 
under  16. 

The  details  of  the  cases  for  1907,  which  are  included 
in  the  above  figures,  are  as  follows : — Reported  to  the 
police,  149  cases  concerning  girls  under  13,  and  178 
concerning  girls  under  16;  total,  327.  Of  these,  97 
of  the  first  and  135  of  the  latter  were  tried,  a  total 
of  232  cases,  roughly  about  two  thirds.  Five  cases 
were  thrown  out,  82  were  acquitted,  145  convicted. 
The  punishment  of  those  convicted  was  penal  servi- 
tude in  23  cases  for  terms  varying  from  four  to  twenty 
years,  five  and  seven  years  being  the  usual  sentence ; 
one  man  was  flogged;  the  remainder  received  terms 
of  imprisonment  from  fourteen  days  to  two  years. 

One  curious  fact  in  this  grim  document  is  the 
distinction  drawn  between  girls  under  and  over  13. 


Appendices  i8i 

All  the  sentences  of  penal  servitude  were  given  in 
the  former  cases,  and  not  one  in  the  latter;  apparently 
a  girl  over  13  and  under  16  may  be  treated  in  the 
most  dastardly  manner  and  the  sentence  be  anything 
between  fourteen  days  and  two  years. 

This  does  not  conclude  the  terrible  sum  of  immoral- 
ity among  the  males  of  this  Christian  land,  for  during 
the  years  quoted — 1893  to  1907 — ^there  were  also 
3407  cases  of  rape,  and  12,280  cases  of  indecent 
assault  upon  women  over  16,  reported  to  the  police, 
altogether  making  the  ghastly  total  of  15,687  cases 
reported,  and  with  the  4744  cases  under  16,  we  have 
the  tremendous  number  of  20,431 — ^an  annual  average 
for  the  fifteen  years  of  1362  women's  lives  wrecked. 
Such  is  the  information  from  the  Blue  Book. 

The  Rev.  Thomas  George  Cree,  Hon.  Secretary  of 
the  Church  Penitentiary  Association,  sent  me  a  very 
interesting  little  pamphlet.  Juvenile  Immorality,  in 
which  he  states  that  he  sent  out  a  circular  to  all 
the  homes  and  refuges  on  their  list  asking  for  the 
number  of  such  children  under  16  dealt  with  during 
the  last  three  years  (up  to  October,  1908).  Re- 
plies from  40  penitentiaries  were  received;  7  did 
not  take  such  cases,  the  33  which  did  returned  347 
cases.  From  55  refuges  the  number  of  cases  returned 
was  745;  total  for  three  years,  1092. 


1 82  Hygiene  and  Morality 

Some  of  the  details  are  as  follows: — 8  cases  be- 
tween 6  and  8  years  of  age;  i8  between  9  and  11 
years;  11  cases  of  12  years;  14  cases  of  13  years; 
121  cases  of  14  years;  and  301  cases  of  15  years. 

In  one  town  the  Chief  Constable  reports  that  hardly 
a  child  over  14  years  has  not  fallen.  From  another, 
that  children  under  14  absolutely  solicit  in  consider- 
able numbers.  In  another,  lads  marked  with  badges 
solicit.  On  inquiring  why  prosecutions  are  so  few, 
the  reply  comes  from  all  quarters  that  so  often  the 
culprit  is  the  father,  step-father,  uncle,  or  brother 
of  the  victim.  In  a  covering  letter,  Mr.  Cree  writes 
that,  besides  the  numbers  already  quoted,  fully 
1000  more  cases  were  known,  but  the  parents  would 
not  allow  the  rescue  workers  to  deal  with  them. 

He  says  convictions  are  very  few,  as  relations  are 
often  the  culprits,  and  prosecutions  must  be  taken 
in  hand  within  six  months  after  the  commission  of 
the  crime ;  and,  when  there  is  danger  of  an  infant  being 
born,  the  child  is  restrained  by  threats  from  saying 
an3rthing  until  its  state  is  manifest. 

Also  young  children  are  subject  to  cross-examina- 
tion by  lawyers,  and  he  states  a  case  of  a  child  of  10 
being  cross-examined  for  a  full  hour,  but  the  evidence 
could  not  be  shaken,  and  the  case  was  sent  to  the 
Assizes. 

From  the  Society  for  the  Prevention  of  Cruelty 


Appendices  183 

to  Children  came  the  statistics  for  last  year — 838. 
cases,  146  prosecuted,  46  being  dismissed. 

Of  collected  cases  there  are  20,  18  of  these  being 
under  16,  one  being  only  3  and  another  5  years  of  age. 
In  two  the  fathers  were  the  culprits,  and  in  one  the 
brother  was  suspected.  In  six  of  these  cases  nothing 
was  done,  either  because  parents  would  not  prosecute, 
or  for  want  of  sufficient  evidence.  Two  of  these  cases 
were  very  bad.  One,  a  girl,  went  to  a  gardener's  for 
fruit  at  midday  on  Sunday,  did  not  return  home 
until  6.30;  then  went  out,  presumably  to  chapel. 
Nothing  more  was  seen  of  her  until  her  body  was  taken 
from  the  river  on  the  following  Tuesday  morning. 
On  examination,  the  child  was  found  to  have  been 
violated.  The  gardener  was  severely  censured  at 
the  inquest,  and  an  open  verdict  given. 

The  other  was  of  a  child  of  12,  who  was  outraged 
while  her  mother  was  lying  dead.  The  child  accused 
her  father  of  the  crime,  but,  as  it  could  not  be  proved, 
he  was  let  off. 

Out  of  II  cases  which  were  investigated,  3  were 
discharged,  i  because  there  was,  as  the  Judge  said, 
"No  corroboration,"  and  i  "not  proven."  Of  the  6 
convicted,  i  was  let  off  with  a  fine,  and  the  others 
received  sentences  varying  from  six  months  to  ten 
years. 

Of  the  two  cases  over  16,  one  was  a  girl  of  17 


1 84  Hygiene  and  Morality 

mentally  deficient,  and  the  culprits  (several  youths, 
one  of  whom  confessed  to  the  wrong-doing)  were  all 
discharged  by  the  magistrates.  The  other,  also  a  girl 
of  17,  was  seized  from  behind,  a  drugged  handkerchief 
stuffed  into  her  mouth,  and  she  was  dragged  into  the 
bracken  off  the  high  road  across  a  Surrey  heath. 
There  she  was  outraged,  and  when  she  recognised  her 
assailant,  he  tried  to  pour  poison  down  her  throat, 
fortunately  without  much  success.  Chiefly  because  of 
the  attempt  to  poison  he  got  seven  years.  I  think 
it  should  have  been  for  life. 

If  such  is  the  condition  of  things  as  they  are  known, 
what  number  of  cases  are  there  unknown?  If  there 
are  327  cases  reported  during  a  year,  how  very  many 
hundreds  are  there  unreported?  Yet  men  who  are 
supposed  to  protect  the  weak  take  every  advantage 
of  that  weakness.  Governments  come  and  go,  yet 
this  terrible  evil  remains  unchecked.  Why  have  not 
these  cases  been  put  in  the  same  category  as  murder? 
Do  our  law-makers  consider  it  worse  to  kill  the  body 
than  to  outrage  its  honour  and  sully  its  soul? 

It  is  useless  to  try,  as  some  may  do,  to  blame  for- 
eigners ;  only  one  culprit  among  all  the  reported  cases 
for  1907  was  an  alien. 

These  men,  who  defile  women  and  violate  their 
own  offspring,  are  British.  They  have  the  power  of 
helping  to    make  the  laws  which  we    women   must 


Appendices  185 

obey,  and,  judging  from  these  statistics,  make  them 
as  easy  as  possible  for  the  indulgence  of  their  own 
lusts. 

If  this  is  not  so,  why  must  cases  be  instituted  within 
six  months  of  the  offence?  Why  must  a  child,  whose 
whole  moral  and  physical  nature  has  been  so  recently 
outraged,  be  subjected  to  cross-examination  by  a 
lawyer  (a  man)  upon  so  delicate  a  matter? 

And,  lastly,  how  is  it  possible  to  expect  corrobora- 
tive evidence  in  the  majority  of  such  cases? 

If  such  a  state  of  things  is  the  result  of  the  absolute 
political  power  of  men,  the  sooner  women  have  votes 
the  better  it  will  be  for  the  nation,  and  the  sooner 
will  its  moral  and  physical  condition  be  improved. 

INADEQUATE  PROTECTION  TO  GIRLS 

"  A  sinister  chapter  to  which  too  little  attention  has 
hitherto  been  paid  is  the  failure  of  our  legislatures 
and  courts  to  afford  to  young  girls  protection  from 
seduction,  assault,  and  enslavement  in  infamous 
houses.  The  difficulty  involved  in  obtaining  the 
conviction  of  malefactors  is  known  only  to  the  few 
faithful  souls  who  have  attempted  to  obtain  due 
punishment  of  these  grave  offences.  Mothers  in  any 
community  are  more  deeply  stirred  by  these  offences 
than  by  any  others,  but  judges  and  juries  vary  be- 


i86  Hygiene  and  Morality 

yond  belief  in  their  treatment  of  criminals  guilty 
of  crimes  against  girls. 

"  In  one  western  State  a  woman  worked  fourteen 
years  to  obtain  the  enactment  of  a  workable  statute 
to  punish  crimes  against  female  minors.  At  last 
such  a  law  was  passed  and  vigorously  enforced.  Four- 
teen criminals  were  sent  to  the  penitentiary.  Then 
a  young  lawyer  offered  his  services  to  one  of  the 
criminals,  to  free  him  by  showing  that  the  law  was 
tinconstitutional  because  the  title  should  have  read 
*to  define  and  punish  crimes  against  female  minors' 
whereas  in  fact  the  two  words  'define  and'  were 
missing  from  the  title,  though  the  necessary  definition 
was  contained  in  the  body  of  the  statute.  Upon 
this  frivolous  ground  the  Supreme  court  of  the  State 
held  the  statute  invalid,  and  nine  of  the  fourteen 
criminals  were  forthwith  freed.  The  others  were  too 
poor  or  too  ignorant  to  obtain  counsel,  and  they 
remained  in  the  penitentiary."^ 

EXAMPLES  OP  LAWMAKING  IN  NEW  YORK  STATE 

The  maximum  punish-  Section  1566  of  the 
ment  that  can  be  given  penal  code  of  New  York 
to    a    "cadet,"   or    man    State,  which  is  conspicu- 

1  Woman  Suffrage:  its  Relation  to  Working  Women  and 
Children,  by  Florence  Kelley,  published  by  the  National 
American  Woman  Suffrage  Association. 


Appendices 


187 


ously  placed  in  the   sur- 
face cars  fixes  one  year's 
imprisonment    and    $500 
fine  as  the  maximum  pen- 
alty for  stealing  or  giving 
away    a    transfer    ticket 
worth  five  cents. 
The  offence  of  ''procuring"  is  graver,  and  is  pun- 
ishable with  the  same  degree  of  severity  as  is  the 
offence  of  spitting  on  the  floors  of  cars  and  public 
buildings. 


who  lives  upon  the  earn- 
ings of  prostitutes,  in 
New  York  State  is  six 
months  in  the  workhouse. 
The  statute  makes  this 
offence  a  misdemeanour. 


APPENDIX  D 

PROTECTION   OF  WIDOWED  MOTHERS 

The  possibilities  of  protection  extended  by  the 
state  to  mothers  with  children  who  are  dependent  on 
them,  not  only  for  care  but  for  a  livelihood,  are  in- 
dicated by  the  systems  of  industrial  insurance  or 
compensation  now  in  force  in  almost  every  civilised 
country  except  this  one.  Every  European  country, 
at  the  present  time,  compensates  the  widows  of 
workmen  who  have  been  killed  in  industry.  In  Eng- 
land the  widow  receives  a  sum  of  money,  while  in 
most  other  countries  she  receives  a  pension  equal  to 
a  part  of  her  husband's  earnings.  This  continues  un- 
til she  remarries,  and  serves  to  protect  the  orphans. 
In  Germany  the  orphans  are  thus  provided  for  imtil 
their  fourteenth  year, — ^the  age  at  which  they  are 
allowed  to  begin  earning. 

One  of  the  chief  aims  of  the  women  of  Australia, 

lately  organised  into  a  political  association  in  order 

to  concentrate  effectively  upon  social  legislation,  is 

i88 


Appendices  189 

to  bring  about  a  higher  degree  of  economic  security 
for  women  who  have  children  to  support. 

The  idea  that  mothers,  who  provide  citizens  for 
the  state,  are  as  fully  entitled  to  state  support  or 
pensions  during  the  time  when  the  children  need 
their  care  as  are  soldiers,  who  fight  for  the  state,  is 
gradually  making  its  way  as  a  part  of  the  new  ideal. 

The  subject  of  industrial  compensation  may  be 
found  in  Workingmen's  Insurance,  by  William  Frank- 
lin Willoughby,  which  is  now  under  revision  and  is 
to  be  published  by  the  Russell  Sage  Foundation. 
Of  Australian  methods  Miss  Alice  Henry,  Hull  House, 
Chicago,  writes  that  the  united  experience  of  all 
workers  there  supports  the  plan  of  the  maternal  sub- 
sidy. Its  abuse  may  be  readily  prevented  by  careful 
administration.  Though  not  yet  universal,  the  prac- 
tice of  enabling  deserving  widows  or  deserted  mothers 
to  keep  the  home  together  is  spreading  in  all  the 
States.  South  Australia  gives  rations  for  children 
if  more  than  one  in  a  family.  New  South  Wales, 
Western  Australia,  and  Victoria  board  the  children 
with  their  mothers  to  the  age  of  twelve.  See  Report 
Interstate  Conference  of  Workers  among  Dependent 
Children,  and  Reports,  State  Children's  Department, 
Adelaide,  Australia;  also  State  Children  in  Australia 
by  Miss  Spence. 


APPENDIX  E 


MINIMUM  WAGE  BOARDS 


"The  minimum  wage  boards  were  established  ...  in 
response  to  an  anti-sweating  agitation.  .  .  .  The  social 
sanction  of  the  minimum  wage  determinations  rests 
upon  the  common  interest  of  society  in  maintain- 
ing among  all  classes  of  people  a  standard  of  living 
comporting  with  the  general  wealth  and  civilisa- 
tion of  the  community,  and  guaranteeing  healthy 
social  progress.  .  .  .  Minimum  wage  boards  .  .  . 
are  composed  of  not  less  than  four  nor  more  than 
ten  members  representing  equally  the  employers 
and  employees  in  the  trade  under  their  jurisdic- 
tion with  a  chairman  elected  by  the  other  members 
but  who  is  not  one  of  the  original  members  of 
the  board.  A  separate  board  is  formed  for  each 
trade." 

[Bulletin  of  the  Bureau  of  Labour,  vol.  x.,  1905,  pp. 
61,  62,  Washington.] 

'*  Equal    pay    for   equal  work  has  been  partially 

recognised    for    the    first    time    in    Australia    under 

private   enterprise   by  a   recent    'determination'  of 

190 


Appendices  191 

the  Drapery  Trade  Wages  Board.  It  is  already 
in  force  in  the  Federal  Public  Service,  in  the 
Junior  Grade  of  the  State  Education  Department, 
and  now  a  beginning  has  been  made  in  private 
enterprise." 

[Vida  Goldstein  in  Jus  Suffragii,  organ  of  the 
International  Woman  Suffrage  Alliance,  January  15, 
1 9 10.  Edited  by  M.  G.  Kramers,  92  Kruiskade, 
Rotterdam.] 


APPENDIX  F 

THE     LIQUOR     TRAFFIC     AND     ITS     ATTITUDE     TOWARD 
WOMAN  SUFFRAGE 

The  National  American  Woman  Suffrage  Associa- 
tion prints  a  leaflet  reproducing  what  it  calls  a  "secret 
circular"  which  was  distributed  by  an  association  of 
brewers  and  wholesale  liquor  dealers  in  a  western 
State  at  the  time  of  a  campaign  to  introduce  a  woman 
suffrage  amendment  into  the  State  constitution. 
This  circular  came  into  the  possession  of  the  daily 
press  and  may  be  found  in  newspaper  files.  It  is 
stated  that  its  authenticity  has  never  been  denied. 
Part  of  its  text  runs  as  follows : 

"It  will  take  50,000  votes  to  defeat  woman  suffrage ; 

there  are  2000  retailers  in  .     That  means  that 

every  retailer  must  bring  in  25  votes  on  election 
day.  ... 

"  We  enclose  25  ballot  tickets  showing  how  to  vote; 
we  also  enclose  a  postal  card  addressed  to  this  as- 
sociation.    If  you  will  personally  take   25  friendly 

192 


Appendices 


193 


voters  to  the  polls  on  election  day  and  give  each  one  a 
ticket  showing  how  to  vote,  please  mail  the  postal 
card  back  to  us  at  once.  You  need  not  sign  the  card. 
Every  card  has  a  number,  and  we  will  know  who  sent 
it  in.  Let  us  all  pull  together  and  let  us  all  work. 
Let  us  each  get  25  votes.'* 


INDEX 

A 

Abolitionist  Congress  in  Geneva,  77 

"  **  "        "        resolutions  of,  77-79 

Accidental  infection  in  syphilis,  31,  38-39 
Acquired  Syphilis,  10 

Age  of  consent,  U.  S.  laws  concerning,  1 16-12 1 
Ages  when  girls  are  ruined,  87-88 
Alcoholism  in  syphilis,  15,  25-27 
Antibodies,  10 
Anti-serum  treatment,  gonorrhoea,  48 

B 

Blindness,  in  gonorrhoea,  46,  51 
Breeding-place  of  the  venereal  diseases,  34 
Brussels  Conference,  first,  81 

**  "  resolutions,  83 

"  "  second,  81,  83-89 

**  "  resolutions,  89-90 

Butler,  Mrs.  Josephine  E.,  69 


Cancer  and  syphilis,  24 
Chancroid,  52 

Clandestine  prostitution,  98,  99 
Colles,  phenomenon  named  after,  19 
Congenital  syphilis,  16-17 
Constitutional  forms  of  gonorrhoea,  46 
Contagious  Diseases  Acts,  The,  68 
Continental  System  of  Regulation  of  Vice,  The,  66 

195 


196  Index 

Control  of  prostitution,  59-103 

Course  of  gonorrhoea,  43 

Crime  and  syphilis,  27-29 

Crusade  of  women  under  Mrs.  Butler,  71 

D 

Dangers  of  regulation,  93-103 

Diplococcus  gonorrhoeae,  40 

Donne,  5 

Double  standard  of  morals.  The,  60-62 

E 

Enfranchisement  of  women  needed,  158-159,  164-166 
Extent  of  prostitution,  152-154 


Girls,  trade  in,  108-109 
Gonococcus  gonorrhoeae,  40 
Gonorrhoea,  40 

"  and  syphilis,  51,  52 

**  course  of,  43 

"  history  of,  41-43 

"  mortality  from,  in  prostitutes,  50 

"  organism  of,  40 

Great  Britain,  regulation  in,  67-75 
Gummata,  16 

H 

Hard  chancre,  12 

Heredity,  syphilis,  18 

History,  white  slave  trade,  104-105 

Hours  of  work,  163 


Immunity,  gonorrhoea,  48 
'*  syphilis,  20 


Index  197 

[  chancroid,  52 
Incubation  period  -<  gonorrhoea,  43 

(  syphilis,  11 
Infantilism,  17 
Initial  sore  of  syphilis,  12 
International  Federation  against  vice,  formation  of,  77 


Laws  covering  age  of  consent  in  U.  S.,  1 16-12 1 

"  share  of,  in  white  slave  trade,  107-108 
Legislation,  efforts  to  amend,  1 09-1 10,  171  ff 
Liquor  traffic  and  woman  suffrage,  186-187 

M 

Martineau,  Harriet,  warnings  by,  68 

Mediate  contagion,  98 

Metchnikoff,  Elie,  5 

Minimum  wage  boards,  185-186 

Modes  of  transmission,  gonorrhoea,  47-48 

"  "  syphilis,  37-39 

Moral  standard,  double,  the,  60-62 
Morals  police,  64 
Morbidity  of  gonorrhoea,  49 

"  **  syphilis,  29,  31 

Mortality  from  gonorrhoea  in  prostitutes,  50 
Mucous  patch,  syphilis,  13 

N 

National  Consumers'  League,  inquiry  into  wages,  162-163 
National  Vigilance  Leagues,  iio-iii 
Need  of  knowledge,  133-136 
Neisser,  experimental  work  of,  9 

"       micrococcus  of,  40 

"       serum  diagnosis  of,  9-10    ■ 
Nervous  system  and  syphilis,  22-24 
Numbers  of  young  men  infected,  154-155 


One-child  sterility,  45 


198  Index 


Para-syphilltic  diseases,  23 

Pasteur  Institute,  8 

Persevering  prostitutes,  numbers  of,  86 

Poverty  and  prostitution,  156 

Prevalence  of  gonorrhoea,  49 

"  "  syphilis,  29 

Prevention  of  venereal  diseases,  129-130 

*'  (individual),  138 

**  **     childhood,  1 40-1 41 

*•  **     youth,  141-142 

"  **     marriage,  143-145 

"  "     accidental,  146-149 

**     (social)  childhood,  160 
**  '*      girlhood,  162 

'*  "      motherhood,  160, 188-9 

Primary  lesion,  syphilis,  12 
**      stage  "         12 

"  "     length  of,  12 

"      infection  in  gonorrhoea,  43 
Profeta,  phenomenon  named  for,  20 
Progress  of  crusade  against  venereal  disease,  74-75 
Prostitutes,  mortality  of,  gonorrhoea,  50 
Prostitution,  34-36 

"  of  minor  girls,  86 

"  attempts  at  legislation  in  U.  S.,  171 

Protest  of  women  against  regulated  vice,  71 
Puberty  and  syphilis,  17 

R 

Race  suicide,  the  true,  52 

Reasons  for  prostitution,  155-156 

Regulation  of  prostitution,  59;  efforts  to  secure  legislation  in 

U.  S.,  171 
Regulationists  in  Medical  Congress,  1873,  76 
Report  on  Criminal  Assault,  176  ff 
Resolutions,  first  Brussels  Conference,  83 

second      "  "  89-90 


Index  199 


Sanitary  inefficiency  of  regulation,  96-99 
Schaudinn,  discovery,  of,  5-6 

"         organism  of,  5 
Second  stage  of  gonorrhoea,  44-45 

"  "      "    syphilis,  13-14 

Select  Committee,  House  of  Commons,  75 

**  "  **       "  Lords  on  white  slave  trade,  75 

Share  of  laws,  in  white  slave  trade,  107-108 
Social  legislation  needed,  163 
Societies,  Sanitary  and  Moral  Prophylaxis,  90-91 
Soft  chancre,  52-53 
Source  and  spread  of  syphilis,  32 
Spirilla  refringens,  6 
Spirocheete  balanitis,  7 
"  pallida,  5 

"  "       destroyed  by  heat,  7 

"  "       demonstrated  in  tissues,  8 

Stages  of  gonorrhoea,  44-45 
"       "  syphilis,  primary,  11 
"       "        "        secondary,  13 
"        tertiary,  14 
Statistics  of  gonorrhoea,  49-52 

**         "  syphilis,  29-31 
Sterility  of  gonorrhoea,  45-50 
Struggle  against  Contagious  Diseases  Acts,  73-74 
Supreme  Court  decision,  115 
Syphilis,  3, 

**         acquired,  10 

**         and  carcinoma,  24 

**         and  crime,  27-29 

*'         cause  of,  4-5 

'*         alcoholism  in,  15,  25-27 

**         congenital,  10,  16-17 

"         course  of,  lo-ii 

"         history  of,  4 

"         mucous  patches  of,  13 

"         and  the  nervous  system,  22-24 


200  Index 

Syphilis,  organism  of,  5 

"  prevalence  of,  29 

"  rash  of,  13 

*•  source  of,  32 

'*  stages  of,  11-14 

"  statistics  of,  29-31 

"  and  tuberculosis,  24-25 

"  and  gonorrhoea,  51,  52 


Tertiary  syphilis,  14 
Third  stage,  gonorrhoea,  46 
Three  stages,  gonorrhoea,  43 
Tolerated  houses,  65-67 
Treponema  pallidum,  7 
Tuberculosis  and  syphilis,  24-25 


Venereal  sore,  52-53 

W 

White  slave  trade,  Europe,  103-104 

United  States,  I  lO-i  1 5 
Widowed  mothers,  protection  of,  185,  188-189 

Y 

Young  men  infected,  numbers  of,  I54~I55 

Z 
Zeissl,  22 


M  Selection  from  the 
Catalogue  of 

G.  P.  PUTNAMS  SONS 


Complete  Catalogue  sent 
on  application 


A  History  of  Nursing 

The  Evolution  of  the  Methods  of  Care  for  the  Sick 
from  the  Earliest  Times  to  the  Foundation  of  the 
First  English  and  American  Training  Schools  for 
Nurses. 

By  LAVINIA  L.  DOCK,  R.N. 

Secretary  of  the  American  Federation  of  Nurses  and  of 
the  International  Council  of  Nurses,  etc. 

and  M.  ADELAIDE  NUTTING,  R.N. 

Superintendent  of  Nurses,  The  Johns  Hopkins  Hos- 
pital ;  Principal  of  Johns  Hopkins  Training 
School  for  Nurses,  etc. 
Two  Vols.,  8vo.    With  80 Full-Page  Illustrations.    Net,  $£.00 

Beginning  with  the  earliest  available  records  of  sanitary 
codes  which  were  built  up  into  health  religions,  and  coming 
down  through  the  ages  wherever  the  care  and  rescue  of  the 
sick  can  be  traced,  through  the  pagan  civilizations,  the  early 
Christian  works  of  mercy,  the  long  and  glorious  history  of  the 
religious  nursing  orders,  military  nursing  orders  of  the 
crusades,  the  secular  communities  of  the  later  middle  ages,  and 
the  revival  of  the  deaconess  order  which  culminated  in  the 
modern  revival  under  Miss  Nightingale,  this  history  is  the 
most  serious  attempt  yet  made  to  collect  the  scattered  records  of 
the  care  of  the  sick  and  bring  them  all  into  one  unified  and 
sympathetic  presentation. 

The  story  is  not  told  in  a  dry  technical  fashion,  but 
presents  its  pictures  from  the  standpoint  of  general  human 
interest  in  a  subject  which  has  always  appealed  to  the  sympa- 
thies of  men. 

Both  Miss  Nutting  and  Miss  Dock  are  well  known  in 
the  nursing  world  ;  Miss  Nutting,  as  one  of  the  foremost  edu- 
cators in  hospital  work,  who,  as  the  head  of  the  Johns 
Hopkins  Hospital  training  school,  has  so  distinguished  her- 
self for  practical  work  that  she  has  been  called  to  Columbia 
University  to  take  the  chair  of  Institutional  Management, 
and  her  collaborator  as  a  well-known  worker  for  organization 
and  progress,  and  who,  as  the  secretary  of  the  International 
Council  of  Nurses,  has  already  written  much  on  nursing  and 
hospital  conditions. 

The  history  is  amply  illustrated,  and  contains  3  copious 
bibliography  of  nursing  and  hospital  history. 

a.   p.   PUTNAM'S   SONS 
New  York  London 


^dofes  for  ^jedical  ^^tudeuts. 


A  Text-Book  for  Training  Schools  for  Nurses. 

By  P.  M.  Wise,  M.D.,  late  President  of  the  New  York 
State  Lunacy  Commission,  etc.  With  an  introduction 
by  Dr.  Edward  Cowles,  Physician-in-Chief  and  Super- 
intendent  McLean  Hospital. 

Second  edition.  Two  volumes,  illustrated,  i6°,  sold 
separately,  each $1-25 

**  This  text  book  has  been  adopted  by  the  ten  State  Hospitals  of 
New  York,  representing  approximately  four  hundred  pupils," 

Dr.  G.  Alder  Blumer  (the  medical  superintendent  of  the  Utica 
State  Hospital)  says:  "It  is  an  admirable  piece  of  work.  It  is 
written  very  clearly,  and  in  language  which  can  be  very  readily 
understood  by  the  nurse.  It  covers  the  whole  ground,  and  contains 
a  great  deal  of  matter  not  to  be  found  in  other  books,  and  with  the 
adoption  of  this  book  other  text-books  will  not  be  required  for  the 
training  school." 

A  Text-Book  of  Materia  Medica  for  Nurses. 

Compiled  by  Lavinia  L.  Dock,  graduate  of  Bellevue 
Training  School  for  Nurses,  secretary  of  the  American 
Federation  of  Nurses  and  of  the  International  Council 
of  Nurses,  etc. 

Fourth  edition,  revised  and  enlarged.     12°.     «^/,  $1.50 

"  The  work  is  interesting,  valuable,  and  worthy  a  position  in  any 
library."— A^.   F.  Medical  Record. 

"  It  is  written  very  concisely,  and  little  can  be  found  in  it  to  criti- 
cise unfavorably,  except  the  inevitable  danger  that  the  student  will 
imagine  after  reading  it  that  the  whole  subject  has  been  mastered. 
The  subject  of  therapeutics  has  been  omitted  as  not  a  part  of  a 
nurse's  study,  and  this  omission  is  highly  to  be  commended.  It  will 
prove  a  valuable  book  for  the  purpose  for  which  it  is  intended."— 
N'.  y.  Medical  Journal, 

Medical  and  Surgical  Nursing. 

A  Treatise  on  Modern  Nursing  from  the  Physician's  and 
Surgeon's  Standpoint,  for  the  Guidance  of  Graduate  and 
Student  Nurses,  together  with  Practical  Instruction  in 
the  Art  of  Cooking  for  the  Sick.  By  H.  J.  O'Brien, 
M.D.     12° net,  $i-5o 

G.  P.  PUTNAM'S  SONS,  New  York  and  London 


**  Practical  experience  speaks  from  every  page  of  the  book— 
this  gives  it  at  once  its  greatest  value  and  its  charm  ,  ,  ,  not 
an  idle  word-  not  a  slired  of  padding  is  to  be  found  between  the 
two  covers/' — Americati  Journal  of  Nursing. 


Practical  Nursing 

A  Text-Book  for  Nurses 

By  ANNA  CAROLINE  MAXWELL 

Superintendent  of  the  Presbyterian  Hospital  School  of 

Nursing 

— AND — 

AMY  ELIZABETH  POPE 

Instructor  in  the  Presbyterian  Hospital  School 
of  Nursing 

Third  Edition.         Revised.         Illustrated.  Crown  Svo* 

S^-7J  «^^.     {Postage  12  Cents) 

•'The  appearance  of  this  work,  the  fruit  of  the  conjoined 
labors  of  Miss  Maxwell  and  Miss  Pope,  marks  a  turning-point 
in  nursing  literature.  Up  to  the  present  time,  the  "text- 
book" and  "hand-book"  of  nursing  have  treated  of  subjects 
which,  while  they  necessarily  and  indispensably  belong  in  the 
curriculum  of  every  school  for  nurses,  are  yet  subjects  quite  apart 
from  practical  nursing  in  the  hospital  wards  or  at  the  bedside  of 
the  sick,  and  quite  out  of  place  in  a  text-book  of  nursing.  One 
needs  to  read  the  book  to  appreciate  it ;  a  mere  enumeration  of 
the  subjects  gives  no  hint  of  the  immense  amount  of  care 
taken  to  quote  methods  which  have  been  proved  by  experi- 
ence in  many  schools  to  be  the  means  best  adapted  to 
give  good  results  and  at  the  same  time  to  insure  the  comfort 
and  confidence  of  the  patient." — Ame-zican  Journal  of  Nursing, 

G.  P.  PUTNAM'S  SONS 
New  York  London 


"  I  consider  it  the  best  I  have  seen  and  shall  recommend  its  use 
in  our  school." — Kate  A.  Sanborn^  Supt,  of  Training  School  for 
Nurses,  St.  Vincents  Hospital. 


Essentials  of  Dietetics 

In  Health  and  Disease 

A  TEXT-BOOK  FOR  NURSES 

By  AMY  ELIZABETH  POPE,  Author,  with 

ANNA  CAROLINE  MAXWELL 

of  "Practical  Nursing"  and  Instructor  in  the  Presbyterian 
Hospital  School  of  Nursing 

and 

MARY  L.  CARPENTER 

'Director  of  Domestic  Science  in  the  Public  Schools 
Saratoga  Springs,  N.  Y. 

Crown  8vo.     Illustrated,     $i.oo  net 


Essentials  of  Dietetics  is  primarily  a  text-book,  intended  to 
facilitate  the  teaching  of  dietetics  in  schools  of  nursing.  Its  aim 
is  to  furnish  nurses  with  such  information  as  is  indispensable, 
and  can  be  assimilated  in  the  time  given  to  the  study  of  dietetics 
in  the  nursing-school  curriculum.  It  is  also  adapted  to  use  as  a 
dietary  guide  for  the  home.  At  least  one-third  of  the  women 
who  enter  the  larger  schools  of  nursing  do  so  with  the  desire  of 
being  prepared  to  take  charge  of  hospitals  or  to  do  settlement 
work,  and  in  both  these  branches  of  the  nursing  profession  hardly 
any  one  thing  is  more  important  than  knowing  how  to  direct  the 
buying,  preservation,  cooking,  and  serving  of  food.  To  do  this 
intelligently  it  is  absolutely  necessary  to  have  some  knowledge 
of  the  chemistry  of  foods,  of  the  special  uses  of  the  various  food 
principles  to  the  body,  of  the  proportions  in  which  they  are  con- 
tained in  the  different  foods,  and  of  the  effect  on  them  of  acids, 
heat,  salt,  digestive  ferments,  etc. 


Q.  P.  PUTNAM'S  SONS 

NEW  YORK  LONDON 


"  An  exceedingly  useful  and  practical  book  for  Nurses  " 

A 

Quiz  Book  of  Nursing 
for  Teachers  and  Students 

By 
Amy  Elizabeth  Pope 

Joint-Author  of  "  Practical  Nursing  **  and   **  Essentials 

of  Dietetics" 
and 

Thirza  A.  Pope 

Together  with  Chapters  on  Visiting  Nursing 

By  Margaret  A.  Bewley,  R.  N. 

Graduate  of  Presbyterian  School  of  Nursing,  and  of  the  Sloane  Maternity 

Hospital,  New  York  City  ;  Instructor  in  Visiting  and  District 

Nursing  in  Presbyterian  Hospital,  New  York  City. 

Hospital  Planning,  Construction,  and  Equipment 

By  Bertrand  E.  Taylor,  A.  A.  I.  A. 
and 

Hospital  Book-keeping  and  Statistics 

By  Frederic  B.  Morlok 

Chief  Clerk  in  the  Presbyterian  Hospital,  New  York  City. 

Crown  8vo.      Illustrated,      Uniform  with  ^^  Practical  Nursing." 

This  book  aims  to  be  useful,  in  the  most  practical  way,  to 
nurses  who  teach,  and  to  those  who  are  studying  under  them.  It 
is,  in  large  part,  a  quiz  book,  offering  in  the  form  of  terse  ques- 
tion and  answer  essential  information  on  a  wide  range  of  subjects 
— the  information  that  is  essential  from  the  nurse's  standpoint. 
Those  who  teach  will  find  these  questions  of  assistance  when  the 
time  they  have  to  devote  to  preparation  for  their  class  work  is 
limited  ;  and  those  who  are  taking  courses  will  find  the  book  a 
great  help  ;  especially  when  studying  for  examinations. 

G.  P.  PUTNAM'S   SONS 

New  York  London 


Second  Edition,  Revised  and  Enlarged 

Short  Talks  with  Young 
Mothers 

On  the  Management  of  Infants  and 
Young  Children 

By 

Charles  Gilmore  Kerley,  M.  D. 

Professor  of  Diseases  of  Children,  N.  Y.  Polyclinic  Medical  School  and 

Hospital ;  Attending  Physician  to  the  N,  Y.  Infant  Asylum  ;  Assist- 

ant  Attending  Physician  to  the  Babies'  Hospital,  N.  Y.  ; 

Consulting  Physician,  New  York  Home  for  Crippled 

and  Destitute  Children  ;  Consulting  Pediatrist, 

Greenwich  Hospital ;  Consulting  Physician, 

SaviUa  Home,  N,  Y. 

Second  Edition,  Revised  and  Enkrged 

With  21  Illustrations 

345  pages,  Crown  Qyo,      $100  net,      {By  mail  $1,10) 


Some  Critical  Comments 

**  It  is  full  of  practical  suggestions  and  has  evidently  been 
written  by  a  man  who  has  had  wide  personal  experience  in  the 
management  of  the  nursery.  It  is  singularly  free  from  all 
theoretical  bias. 

"  Every  word  that  Dr.  Kerley  has  to  say  on  the  subject  of 
these  habits  is  worth  attention  and  is  useful  not  only  for 
mothers,  but  for  practitioners  also,  who  are  frequently  con- 
sulted on  these  matters." 

"The  directions  for  the  feeding 'of  infants  and  young 
children  are  very  simple  and  in  accordance  with  the  best  mod- 
ern principles. 

"  We  highly  commend  the  diet  schedules  which  are  drawn 
up  for  the  children  of  from  one  year  to  six  years  of  age." 

— London  Lancet. 

•*  It  is  one  of  the  books  for  which  persons  of  experience 
feel  profoundly  grateful.  .  .  .  This  book  is  clear,  sensible, 
exhaustive,  and  interesting.  It  is  not  too  large  to  be  conven- 
iently handled  and  the  print  is  very  clear." — The  Criterion, 


G.  P.  Putnam's  Sons 

New  York  London 


DATE  DUE 


06MC0  38-296 


}    i»** 


COLUMBIA  UNIVERSITY  LIBRARIES 


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